Thisbookisdedicatedtothememoryofmyfather,DonaldM.Barnard,MD,a

kindandwisephysician,andtotheparticipantsinourresearchstudies.Iam

deeplygratefulforyourimportantcontributiontothiswork.

“Dr.Barnard’ssolidscientificwork…representsamajorturningpointinthe

treatmentandoutcomeofdiabetes.Revolutionaryinitsimplicationsand

spectacularinitsclarity,thisbook—withitssimple,safedietaryapproach—will

bringhopetomillions.”

—HansDiehl,DrHSc,MPH,FACN,chairmanoftheLifestyleMedicine

InstituteinLomaLinda,California,anddirectoroftheInternational

NutritionresearchFoundation

“Dr.Barnard’ssuperbbookshowsusthenumerousadvantagesoffollowinghis

nutritionalprogram.”

—WilliamC.Roberts,MD,editorinchiefoftheAmericanJournalof

CardiologyandexecutivedirectorofthebaylorHeartandVascularInstitute

inDallas

“Apromisingalternativedietaryapproachinthetreatmentofdiabetes.”

—WilliamE.Connor,MD,professorofmedicineandclinicalnutritionat

OregonHealthandScienceUniversityinPortland

CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION:ANEWAPPROACHTODIABETES
PART1.THEBREAKTHROUGH
CHAPTER1.TheNewBasics
CHAPTER2.ReversingType2Diabetes
CHAPTER3.ARevolutioninType1Diabetes
PART2.THEPROGRAM
CHAPTER4.APowerfulNewMenu
CHAPTER5.HowtoGetStarted
CHAPTER6.HealthfulWeightControl
CHAPTER7.HowtoTestYourselfandTrackYourProgress
CHAPTER8.APerfectDietinanImperfectWorld
CHAPTER9.Troubleshooting
CHAPTER10.WhichSupplementsShouldYouTake?
CHAPTER11.ExercisefortheRestofUs
PART3.COMPLETEHEALTH
CHAPTER12.AHealthyHeart
CHAPTER13.HealthyNerves,Eyes,andKidneys
CHAPTER14.InformationforClinicians
MENUSANDRECIPES
NOTES

ACKNOWLEDGMENTS

I would like to thank the many doctors, nurses, dietitians, and people with

diabetes who used the first edition of this book and shared their experiences

alongtheway.Theyhaveunderscoredthepowerofthisapproachandthegreat

needforitatatimewhenthecausesofdiabetesandthenutritionalapproachtoit

remainonlydimlyunderstoodbyasurprisinglylargenumberofcaregiversand

patients.

Theresearchthatculminatedinthisbookwasateameffort.Iespeciallywant

toexpressmydeepestappreciationtotheresearchvolunteerswhoputupwith

manyearly mornings,late nights,and needlesticksin performingan important

public service. You have taught me a great deal and helped our research

immeasurably.

I greatly appreciate the support of the National Institute of Diabetes and

DigestiveandKidneyDiseasesoftheNationalInstitutesofHealth,particularly

Sanford Garfield, PhD, and of the Diabetes Action education and Research

Foundation and its director, Pat DeVoe, RN, BSN, without which our initial

researchondiabetes wouldnothave beenpossible.Thankyou alsotoGEICO

forallowingustotestthisapproachintheworksettingincitiesacrosstheUS

and to the American Diabetes Association for the opportunity to share our

findingsalongtheway.

JoshuaCohen,MD,ofthedivisionofendocrinologyatGeorgeWashington

University,wasinstrumentalinplanningandguidingourresearchwork.David

J.A.Jenkins,MD,PhD,DSc,oftheUniversityofToronto,isanextraordinary

mentor whose generosity with his time, knowledge, and ideas is something I

hopetopassontootherinvestigators.

CarolineTrapp,DNP,ANP-BC,CDE,FAANP,hasappliedthisapproachin

extraordinary ways in her clinical work and in her innovative programs with

NativeAmericansand,alongwithMeghanJardine,MS,MBA,RDN,LD,CDE,

haseducatedandempoweredthousandsofcaregivers.

Susan Levin, MS, RD, Francesca Valente, Rosendo Flores, Jill Eckart,

SuruchiMishra, PhD,Joseph Gonzales,RD,Gabrielle Turner-McGrievy, PhD,

RD,andLisaGloede,RD,CDE,helpedextensivelyinresearchplanningandin

guiding our research participants toward more healthful ways of eating. Brent

Jaster,MD;AmberA.Green,RD;KimSeidl,MS,RD;TrulieAnkerberg-Nobis,

RD;DulcieWard, RD;JenniferReilly,RD;and MaryEllenWolfe, RN,CDE,

andRobynWebbsharedtheirexpertiseandguidancewithmeandourresearch

participants.ThankstoPaulPoppen,PhD,forhisexpertassistanceinplanning

andexecutingthestatisticalanalyses.AndrewNicholson,MD,andMarkSklar,

MD, guided our initial research on diabetes, and Larry Kushi, PhD, provided

thoughtful advice along the way. John A. McDougall, MD, and Mary

McDougallprovidededucationalmaterialsandwonderfulrecipes.JennieBrand-

Miller,PhD,oftheUniversityofSydney,kindlyansweredmanyquestionsabout

herstudiesoftheglycemicindexanditsuseinclinicalpractice.

Stanley Talpers, MD, kept a watchful eye on medical issues for our

participants,andBradMoore,MD,servedasoursafetyofficer.

SpecialthankstoErnestP.Noble,MD,PhD,andTerryRitchie,PhD,ofthe

University of California, Los Angeles, for their generosity and expertise in

genetic analyses. Thank you to Donald S. Karcher, MD; Terry Costa; Luce

Merino; Estela Day; Patrice Moore; and everyone at George Washington

Universityclinicallaboratoryclientservices.

CaelCroftprovidedthewonderfulmedicalillustrationsinthisbook.

Finally,thankyoutomyliteraryagent,BrianDeFiore,andmyeditor,Marisa

Vigilante,forhelpingtoshapethisbookintoitscurrentform;andBryannaClark

Groganforprovidingwonderfulrecipes.

INTRODUCTION

ANewApproachtoDiabetes

This book presents a revolutionary method for preventing, controlling, and

reversing diabetesbased on important researchfindings that have dramatically

changedourunderstandingofthiscondition.Whenthisbookfirstappeared,the

ideathatdiabetescouldimprovedramaticallyandsometimesevengoawayfor

allintentsandpurposeswasanovelconcept.Theprevailingnotionwas“once

youhavediabetes,you’llalwayshavediabetes,”andtheconditionjustseemed

toleadtomoreandmorecomplications.Wehavechangedthatscenario.

In studies by my research team, funded by the US government’s National

InstitutesofHealthandtheDiabetesActionResearchandeducationFoundation,

along with the work of other researchers, we have completely redesigned the

dietaryapproach todiabetes. Ifyourexperience withdiabetes hasbeenone of

gradually escalating medication doses, ever-increasing weight, and increasing

worry about the risk of complications, you will learn how to reverse those

trends.

Wewillfocusonchangesinyourmenu,notondrugs.Yes,medicationsoften

have their role. But I would much rather help you scale back on drugs—or

eliminatethementirely.Doingthatmeansrethinkingthefoodsthatyoueat.Let

meemphasizethatyouwillnotneedtocutcalories,limitcarbohydrates,orstick

to small portions. In fact, you can eat until you are full. If you get hungry

betweenmeals,youarefreetoeatmore.Whatwewillzeroinonisthetypeof

foodyoueat.Thathasemergedasthecriticalfactor,asyouwillsoonsee.

ANEWIDEA

My father, Donald M. Barnard, MD, spent hisentire life treating diabetes. He

grew up on a family farm in the Midwest but soon realized that the cattle

businesswasnotforhim.Hedecidedtogotomedicalschool,andaftertraining

atBoston’sfamed JoslinClinic,hebeganwork atabusy communityhospital.

Hebecameknownasthediabetesexpertforthesurroundingarea.Butheandthe

otherdoctors—andtheirpatients—oftenfounddiabetespuzzlingandfrustrating.

Herecounteda tellingcommentmadeby theclinic’sfounder, ElliottP.Joslin,

MD,about diabetesresearch: “Gentlemen,wedon’tneeda bigresearchgrant.

Whatweneedisanewidea.”

Dr. Joslin made that observationback in the 1950s, and the need has only

grown more urgent as the incidence of the disease has exploded. Worldwide,

more than 400 million people are living with diabetes. Until now, most have

foundtheconditiontobeatbestanexerciseindrudgery.Withdailybloodtests

andagrowinglistofmedicationsthataimonlytoslowthedisease’sinevitable

damage,apatient’slifebecomesawaitinggame,withonecomplicationarising

after another—from nerve symptoms to visual changes and heart and kidney

problems.

Now,atlast,wehaveamuchmorepowerfulapproach.I’mtalkingnotjust

aboutaboldnewidea,butaboutanentirelynewapproachtodiabetesthathas

beentestedandproven.

In a series of research studies conducted first with Georgetown University

and George Washington University in Washington, DC, our research team has

proven that many people with diabetes can think beyond delaying inevitable

decline and improve their health dramatically. They can cut their blood sugar,

increaseinsulinsensitivity,andreduceoreliminatemedications,andtheycando

this with a simple set of diet changes. Unlike with medication treatments, the

“sideeffects”ofthemenuchangearegoodones:weightloss,lowercholesterol

levels,lowerbloodpressure,andincreasedenergy.

From the beginning, our studies aimed higher and took a more aggressive

approachtodiabetesthanclinicianshadinthepast.Thefirststudywassmall—

just13patients—andittestedaprogramthatreliedentirelyonchangesindiet.

Therewasnonewdrug,nomagicalsupplement—notevenanexerciseprogram.

Buttheresultswereamazing.Two-thirdsofpatientsimprovedsomuchthatthey

wereabletoreduceoreliminatetheirmedicationswithin12weeks.Thestudy

waspublishedinPreventiveMedicinein1999.

Then,inasecondstudy,thisoneinvolving59patientswithvaryingdegrees

of blood sugar control—some healthy, others prediabetic or diabetic—we

studiedwhydietchangeworks.Itbecameclearthatthedietshiftactuallycaused

afundamentalchangeinthebodyitself.In14weeks,thedietledtoa24percent

improvement in insulin sensitivity—that is, the body’s ability to respond to

insulin,thesugar-storinghormonethatisdysfunctionalindiabetes.Participants

whosebloodsugarlevelswereintheabnormalrangesawthempromptlyreturn

towheretheybelonged.Whileexercisecouldincreasethebenefitsevenfurther,

dietchangesalonewerepowerfulenoughtoboostinsulinsensitivityandbring

blood sugar under better control. The results were presented at the American

Diabetes Association Scientific Meeting in 2004 and were published in the

AmericanJournalofMedicinein2005.

These studies suggested that thisnewapproach may be the most powerful

nutritional plan ever devised for diabetes. We can do more than try to

compensate for malfunctioning insulin, as doctors have done for decades with

variousmedications.Rather,wecanhelpthebody’sowninsulinworkproperly

againbydirectlyaddressing—andimproving—thecells’sensitivitytoit,which

is the key issue in type 2 diabetes. Even when the disease has evolved to the

point of serious complications, it is not too late for marked improvements to

occur.

Starting in 2003, with the support of the National Institutes of Health, we

conducted a new research trial to compare our diet, head-to-head, against the

guidelines promulgated by the American Diabetes Association at that time.

Theseconventionalguidelinesseemedsensibleandwerewellaccepted.Millions

ofpeople followed them,carefully cuttingcalories andlimiting carbohydrates.

But all too often, a familiar story ensued: Despite everyone’s best efforts, the

diseasetypicallyworsenedovertime.Ourgoalwastoseeifwecouldimprove

things. The study was conducted with George Washington University and the

University of Toronto and included 99 individuals with type 2 diabetes. The

participantswererandomlyassignedtoeitherastandarddiabeticdietbasedon

the 2003 ADA guidelines or to the more aggressive diet you will learn about

shortly. Along the way, I presented the study’s initial results at scientific

meetingsoftheADA,theAmericanAssociationofDiabetesEducators,andthe

AmericanPublicHealthAssociation.

In a careful analysis that kept exercise and medication use constant, we

foundthatthenewdietcontrolledbloodsugarthreetimesmoreeffectivelythan

theprevious“best”diet.Italsoacceleratesweightlossandcontrolledcholesterol

betterthantheoldgoldstandard.Otherinvestigatorshaveshowedthatthiskind

ofdietalsohasdramaticbenefitsfortheheartandleadstoabigimprovementin

bloodpressure.Itallowsmanyindividualstotakechargeoftheirlivesagainand

toreturntohealthandvigor.

WethenrantwostudieswithGEICO,theinsurancecompany,toseehowit

wouldapplyintheworksettingin10differentcities.Inaword,itworksgreat

and is easy to implement. We have also documented its efficacy against more

advanceddiabetes,focusingonimprovementsinnervesymptoms.

This book translates these scientific breakthroughs into tools that you can

use,includinganeasy-to-followplanwithsimpledietguidelines.

ANEWUNDERSTANDINGOFTYPE1DIABETES

Type 1 diabetes is much less common than type 2. It is usually diagnosed in

childhood and is invariably treated with insulin—hence its former names,

childhood-onsetdiabetesandinsulin-dependent-diabetes.

Unlike peoplewith type 2 diabetes, thosewith type 1 always needto take

insulin.Buttheycanusedietandlifestylechangestokeepdosestoaminimum

andreducetheriskofcomplications.Wealsohaveanewunderstandingofthe

fundamental causes of type 1 diabetes. It may surprise you to learn that the

process that leads to type 1 diabetes begins when the body’s immune system

attackstheinsulin-producingcellsofthepancreas.Asyouwillsee,newresearch

hasrevealedwhatappearstosparkthisattackandwhatcanhelptopreventit.

PERSONALSUCCESS

Let’s take a look at the experiences of real people who followed the program

describedinthisbook.

Nancy

Nancy learned about our research study from an advertisement in the

WashingtonPost.Shehadbeendiagnosedwithtype2diabetes8yearsearlier.A

cousinofhershadlostsomeofhiseyesighttothedisease,andfailedkidneysleft

himondialysis.Nancydidnotwantthattobeherfuture.Shewasgoingtofight

back.

Beforeshe joinedour study, thingshadbeengoingin thewrong direction.

Although she had followed a diet designed for diabetes, her blood sugar was

graduallyworsening,andthedietdidnothingtostopherweightfromcreeping

upward.

Two years after her diagnosis, her doctor put her on her first diabetes

medication. Eventually, her doctor felt she needed two medications. Still her

bloodglucoselevelcontinuedtorise.Assheenteredourstudy,herhemoglobin

A1Clevel—thekeyindexofbloodglucosecontrol,whichoughttobebelow7.0

percent—wasanunhealthy8.3percent.

Nancyjoined thestudybecause sheliked thefocuson foodrather thanon

drugs.Withtheexplosionofdiabetesinthepopulation,sheintuitivelyfeltthat

theproblemhadtobethekindsoffoodweeatandthatthesolutionhadtobe

there,too.

Weshowedherhowtochangeherdiet.Therewerenolimitsonhowmuch

she could eat or on how many calories or grams of carbohydrates she could

have.Butwedidaskhertomakeamajorchangeinthetypeoffoodshechose.

Atfirst,wealsoaskedhernottoexercise—thatis,nottochangeherexercise

habits—becausewewantedtoseewhatdietchangesalonecoulddo.Thatsuited

her just fine—she was very busyather office, working long hoursevery day,

andexercisewasnotexactlyherthing.Atleastnotyet.

As she began to follow our recommendations, her weight started to fall,

along with her blood glucose, the latter with surprising speed. After years of

goingupandupandup,thetrendstartedtoreverse.After11weeks,shestood

onthescale:Shehadlost14pounds.Andwhensherolleduphersleeveandwe

checkedherA1C,wefoundthatithaddroppedfrom8.3percentto6.9percent.

Allinabout3months’time.Herinsulinsensitivitywasreturning.

Nancy’sbloodsugarcontinuedtofall.Infact,itfellsomuchthatitbecame

clearthathermedicationswerenowtoostrongforher.Thecombinationofthe

drugsshehadbeentaking,alongwiththenew,powerfuldietchanges,actually

leftherbloodsugartoolow.Itwastimetoreducehermedications.Butaswecut

backonherdoses,itturnedoutnottobeenough.Afterseveralmoremonths,we

hadtostoponeofthemaltogether.

Alittlemorethanayearafterjoiningthestudy,shewas40poundslighter.

She stopped her diabetes medications, and yet her A1C is better than it was

before—6.8percentatherlasttest.

“Thepayoff is justincredible,” shesaid. “But it’snot just theweight loss.

Mynumbershavegottendramaticallybetter.”

Andtherewasmore—anotherbenefitshehadnotanticipated.Foryears,she

hadhadarthritispainsosevereshecouldnotopenajar.Afterafewmonthsofa

new diet, she suddenly realized that her arthritis symptoms were completely

gone. (There is actually a fascinating body of scientific literature on diet and

arthritis,which I summarizedin an earlierbook, Foods That Fight Pain.)The

bestpartofthestory:Nancy’s experienceisnot unusualfor peoplewho make

thedietchangesyouwillreadaboutshortly.

Vance

Vancewasjust31yearsoldwhenhewasdiagnosedwithdiabetes.Hehadjust

changedtoanewdoctor,andthediagnosiscameafteraroutinebloodtest.Both

ofhismother’sparentshad hadthedisease,butup untilthatpoint, Vancehad

beeninmoreorlessgoodhealth.Hehadbeenapoliceofficerfor12yearsand

nowworkedinabank,andhewasnotinthehabitofcallinginsick.

Diabeteschangedeverything.“IfIdidn’tlosealegorgoblind,Icouldend

upondialysis,”hesaid.Andthetruthwas,hewasnotinsuchperfectshape.He

had gradually gained weight over the years, and at just under 6 feet tall, he

weighed276pounds.“Ididn’treallytakemydietormyhealthveryseriously,”

he said. “I grew up on steak sandwiches, pork chops, and chicken. We had

barbecuesandcookouts.Wehadsomevegetables,butnotalotoffreshfoods.I

didn’texercise.Ijustdidn’ttakeanyofthisveryseriously.”

Along with weight problems came difficulties with sexual performance.

Impotence affects many men with diabetes and is common in men who are

overweight. His doctor started him on metformin, a commonly prescribed

medicationforreducingbloodsugar.

Vancelearnedaboutourresearchstudyanddecidedtovolunteer—despitea

few misgivings about the prospect of changing his diet. “I never had any diet

restrictionsorrulesbefore,”hesaid.“Inevertriedtocontrolmydietbefore.I

always ate whatever I wanted.” But his wife had been a vegetarian for some

time,andshewasexcitedthatVancewasreadyforachange,too.

Thepayoffcameprettyquickly.Hisweightstartedtofall,andoverayear’s

time,helost—tohissurprise—about60pounds.HisA1C,whichhadbeen9.5

percent at the beginning of the study, fell to 7.1 percent after just 2 months.

Fourteen monthsinto the study,it had dropped to 5.3 percent.His doctor was

thrilledandsaiditwastimetostopthemetformin.

One more surprise: His problems with sexual performance virtually

disappearedwithin3months.“Ihaven’tbeeninthisgoodshapesinceIwasin

thepoliceacademy.Itislikeaweighthasbeenliftedoffofme,”hesaid.“When

I toldmy mother what Iwas doing—that Ihadchanged my diet—shewas so

happy,shenearlycried,becausemydaddiedat30.Whenmygrandfatherdied,I

wastheoldestmaleinmyimmediatefamily.Wetendtocheckoutprettyquick.

ButshesawIwasonadifferentpath.Iwastakingcareofmyself.”

SUCCESS

Assoonasthefirsteditionofthisbookappeared,webegantohearfrommany

more people who were putting this method to use and achieving surprising

results.AreaderinEnglandsentthismessage:

I was diagnosed with type 2 last September and was given the

standarddiet/lifestyleadvicebymydoctorandhiscolleaguesherein

theUK.Initiallymydiabeteswasmildandwasmanagedsimplywith

diet/exercise. With time, however, there was deterioration, requiring

strongerandstrongermedication,andIbegantoexperiencetheearly

stagesoftypicaldiabetescomplications.IwasgivenacopyofNeal’s

bookbyacaringandconcernedfriend.Iwasskepticalatfirstbecause

allthe(difficulttomaintain)dietchangesIhadmadetothatpointdid

not seem to be of any use in tackling the problem. However, I

embraced the plan in the book and really began to enjoy eating the

foodsrecommended.

Three months after starting out on Neal’s diet, I have had my

second(sincediagnosis)review.Iwascalledintothedoctor’sofficeat

veryshortnoticewithnoexplanationgivenbytheadministratoronthe

phone,justbeingtoldthat“weneedtoseeyoutodaytodiscussyour

blood results from last week.” Obviously I was anxious, to say the

least,andwasquiteworriedjustwhatbadnewsthedocwasgoingto

deliver.ThedoctorcalledmeinhowevertoaskmewhatIwasdoing

because “your blood picture is now more normal than mine, and I

don’thavediabetes.”Hethensaid“Ican’ttellyouthatyounolonger

havediabetesbecausethereisnocurefordiabetes,buttechnically,you

don’t.”

Mydoctorwasshockedatmybloodnumbers;hesaidthatthemost

improvementhehaseverseenuptothatpointwastypicallynomore

than5to10percentinhisbest-manageddiabetespatients.Myblood

numberswereapparentlymorethan60percentbetterthanmylastset

ofresultsinJanuary(beforeI startedNeal’s diet).Mydoctor isnow

recommendingNeal’sdiettohisotherpatientswithdiabetes.

Anotherreader,Patricia,wasworkingasadefenseanalystatthePentagon.

Formostofherlife,shehadstruggledwithherweight,andeventuallyshewas

95poundsheavierthanshewantedtobe.Atage58,shedevelopeddiabetesand

hadblockedarteriesinherheart.Shewasmakingtripstodoctors’officesmuch

moreoftenthanshewouldhavelikedandwastaking13pillsandtwoshotsa

day.

But she learned about our approach and put it to work. Patricia ended up

losing95pounds.Shegotoffallherdiabetesmedications.Shehasmoreenergy

thanshehashadinyears.Herhusbandfollowedherlead,andheslimmeddown,

too.Theyaredoingthingstheycouldn’tdobefore,andtheyfeelgreat.

AwomaninPortlandwrotethatshehadstartedgainingweightafterthebirth

ofhersecondchild.Sheworkedeveningsatacatalogcallcenter,andwhenshe

got off work, she found herself at the drive-thru on the way home, ordering

unhealthythingsandmorefoodthansheneeded.Overtime,shegainedalmost

100pounds.

Thatextraweighttookarealtoll,anditgraduallyrobbedherofthingsshe

lovedtodo.Oneyear,herfamilywenttoDisneyland,andshefoundthatshewas

reallynotabletowalkaroundthevarioussights.Shehadnoenergy,andherfeet

hurt.Afterahalf-hour,shewaspooped,andshehadtoleave.

Oneday,theoccupationalnurseatworkcalledherurgentlytoletherknow

the resultsof some blood testsshe had had. Herfasting blood sugar was278,

whichlookedlikeout-of-controldiabetes.

Thiswasamajorwake-upcall.Shewasnotjustheavy;shewasintrouble.

Well,shefoundinformationfrommyteamabouttacklingweightproblems

anddiabetes.Ourmethodfocusedonfoodandallowedhertoeatasmuchasshe

wanted,zeroing inonthe typeoffood sheate. Thatsounded reallyappealing,

andshejumpedin.

Inthefirst3weeks,shelost7pounds,andherbloodsugarwasstartingto

fall,too.Afterayear,shewasdown60pounds.Andtodaysheisattheweight

shewantstobe.

Andwhataboutherdiabetes?Well,herA1Cbloodtestwas10.1whenshe

started—that’s way into the diabetic range. But it gradually came down and

down and down, and today it is well below the diabetic range. And her

cholesterolplummeted63points.

And her energy is back. Remember the problems she had trying to walk

aroundDisneyland?Well,todaysheisonherfeetforhoursatatime,running

trainingcoursesfornewemployees.Andshehasenergytoburn.

Herskinusedtobeblotchyandred.Andnowit’sbacktothewayitshould

be.Headaches,stomachaches,andpainsinherfeethaveallgoneaway,andshe

feelsgreat.

Shehastakencontrol,sheddingthatweightandgettingherenergyback.And

sheloveseatinghealthfulfoodsthatworkforher,notagainsther.

There are many, many more stories ofgreat success from real people. But

nowisthetimeforyoutobeginyourownsuccessstory.

TAKINGCONTROL

ThedietembracedbyNancy,Vance,andtheothersyouhavereadabouthere—

and that I hope you are about to begin—is designed to do much more than

simply palliate diabetes, as other diets do. It is designed to tackle the

fundamentalcausesofthedisease.

Asthosewhoparticipatedinourstudylearned,bloodsugarlevelsthatcreep

steadilyupwardcanalsofall.Theroadtodiabetesisinfactatwo-waystreet.

Whetheryouhavetype2diabetesandwanttogaincontrolofyourhealthor

havetype1diabetesandneedtoreducethedisease’sintrusiononyourlife,this

programwasdesignedwithyouinmind.

However, our research—and this book—also targets a broader purpose.

Moreandmorepeople,includingasurprisingnumberofchildren,arediagnosed

withdiabeteseveryday.Theyandtheirfamiliespayahighpersonalpricewith

the condition. And clinics, health maintenance organizations, insurers, and

governmentprograms arestruggling tokeep upwith prescriptioncosts, doctor

visits,andhospitalizationchargesforitsmanycomplications.Formanypeople

atrisk,itissimplyamatteroftimebeforetheyarediagnosed.Itisourhopethat

anewdirection indietandnutrition,if appliedbroadlyenough,can goalong

waytowardsolvingtheseproblems.

Thisprogramistrulyarevolutioninthewaywethinkaboutthisotherwise

unforgivingdisease.Diabetes isnolongera conditionyousimply havetolive

with.Itneednotslowlyandinevitablygetworse.Quitetheopposite.Ifyouhave

diabetes,itistimeforyoutogetyourlifeback.

Wewillnotcatertoyourdiabetes.Rather,thisprogramisdesignedtohelp

youunderstandthecauseofdiabetesandhowtocorrectittothefullestextent

thatdietandlifestylechangespossiblycan.Ifyoudonothavethediseasebut

areatrisk,thisisapowerfulprogramforpreventingit.

“Is this program for me?” you may be asking. The answer is an emphatic

yes.Here’swhy.

• Whetheryouliketocookorprefertoeatatrestaurants,youcaneasily

make the diet changes you need. I make this point because some people

imagine that changing their diet means making every meal in their own

kitchens.Translation:hoursandhoursofwork.Ifyouinwardlygroanatthat

thought,Icertainlysympathize:Ilearnedlongagothatmytemperamentis

notsuitedtospendingmuchtimeinthekitchen.PerhapsIwasbornwiththe

“roomservicegene,”andmaybeyouwere,too.SoIwillshowyouhowto

planahealthfulmenuandhowtomakeitworkforyouwhetherornotyou

liketocook.Manyofourresearchparticipantstravel,eatatrestaurants,or

eat in theircompany cafeterias. This program worked for them,and it can

workforyou.

• Itdoesnotmatterwhetheryouloveexerciseorhaveneverbeenableto

stickwithanexerciseplan.Theimprovementsdescribedaboveweremade

withoutexercise.Infact,ourresearchstudiestypicallyomitexercisebecause

weneedtoisolatetheeffectofdietchangesinordertoputthemtoagood

test.Havingsaidthat,exerciseisanimportantpartofanydiabetestreatment

regimen, and this book will show you how to bring it into your life in a

sensible, safe, and effective way. If, however, you are unable to engage in

significant exercise because of joint problems, a heart condition, or severe

obesity,orifyoufindyou’rejustnotabletostickwithanexerciseprogram,

you will be glad to know that the benefits of our diet change are not

dependentonanyalterationofyouractivitylevels.

• If you have felt that you just cannot stick with a diet, I completely

understand. That’s why we will focus solely on what you eat, not how

much.Youcaneatuntilyouarefullandhavesnackswhenyouwantthem.

You will have to invest some energy, however: You will have to learn to

think about food in new ways. And you will have to unlearn some old,

outdatednotions.Andifyouhavebeenoverweight,itisverylikelythatyou

willhavetobuysomenewclothes!

WHATDOESITMEANTOREVERSEDIABETES?

Mostpeoplewithdiabetes findthemselveson aroadleading towardgradually

increasingweight, slowlyrising bloodsugar, higherdoses ofmedications, and

worsening complications. Reversing diabetes means reversing this trend. If

weightisanissue,itcancomedown—gradually,butdecisively.Bloodglucose

valuesthathavegoneupcanalsocomedown.Dosesofmedicationsthathave

risen again and again can come down, too. Symptoms such as neuropathy—

nervepaininthefeetandlegs—canimproveandevendisappear.Heartdisease

canbereversed.

Will the disease go awaycompletely? Some people wouldarguethatonce

someone has diabetes, that person will always have it, even if blood tests

improvesomuchthattheconditionisnolongerdiagnosable.Whattheymeanis

that the genetic traits that made type 2 diabetes possible do not go away, and

type1diabetesrequirescontinuedinsulintreatmentsregardlessofhowwellyou

adjustyourdiet.

Itisnotpossibletosayinadvancehowfaryoucango.Willyoubeableto

reduce your medication doses, eliminate some or perhaps all of your

medications,ordriveyourbloodsugardownsofarthatnoonewouldeverknow

you oncehad diabetes?These are questionsyour own experiencewill answer,

butIcanpromisethisbookwillteachyouwhatyouneedtoknowaboutputting

apowerfulfoodprescriptiontowork.Therestofthestoryisyourstowrite.

Iwould bevery gratefulif youwould letothers knowwhat youare doing

and perhaps lend this book to your friends or family members who have

diabetes. We know that we can turn this disease around for individuals, but

conqueringaninternationalepidemicisatallorder,anditrequiresateameffort.

I hope you will join in this important cause along with health professionals,

researchparticipants,andtheirfamilies.

Thankyou,andtheverybestofluckwiththisprogram.

PART1

TheBreakthrough

CHAPTER1

TheNewBasics

In recent years, much of what we thought we knew about diabetes has been

turned on its head. What is now coming into focus is an understanding of its

fundamentalcauses,andthatgivesuspowerweneverhadbefore.

Tomakesureweareatthesamestartingpoint,letmewalkyouthroughthe

basics: symptoms, diabetes types, and typical treatments as they are currently

used.ThenIwillshowyouwhat’snew.

HOWDOWEKNOWIT’SDIABETES?

First,let’smakesenseofthesymptoms.Diabetesmayarrivewithnosymptoms

atall,butoftenitstartswithfatigue.Fornoapparentreason,yoursparkisjust

no longerthere. It may alsoseem that youarelosing water morerapidly than

youshouldbe,whichistosaythatyoumaketripstothebathroommoreoften

thanusual.Andyouarethirsty:Youfindyourselfdrinkingasurprisingamount

ofwater.

Hereiswhatisgoingon:Thefundamentalproblemisthatsugarisnotable

to pass from your bloodstream into the cells of your body. From that single

problemcomeagreatmanyothers,likeonedominoknockingoveranotherand

anotherandanother.

Thesugarwearespeakingofisglucose—oneofthesmallestandsimplest

sugar molecules. In this case, sugar is not just another word for junk food or

emptycalories.Thefactisthatthecellsofyourbodyusethiskindofsugar—

glucose—as an energy source. Like gasoline for your car or jet fuel for an

airplane,glucoseisyourbody’sfuel.Itpowersyourmovements,yourthoughts,

andmoreorlesseverythingyoudo.

Andthatisexactlytheproblem.Ifglucoseisunabletoenteryourcells,they

are deprivedof their basic fuel, soyoulose your energy. That iswhy you are

fatigued.Ifyourmusclesdonothavetheglucosetheyneedforpower,youtire

easily.

Meanwhile,theglucose thatcannotgetintoyour musclecellsbuilds upin

your bloodstream. It becomes more and more concentrated in the blood, and

eventuallyitstartstopassthroughthekidneysandendsupinyoururine.

Now,asglucosepassesthroughyourkidneys,itcarrieswateralongwithit—

lotsofwater, henceallthosetrips tothebathroom.What follows,naturally, is

thirst—youarelosingallthosefluids.Sofatigue,frequenturination,andthirst

are all symptoms of one problem: glucose is having trouble getting into your

cells.

You may also find that you are losing weight. And no, this is not an

especiallywelcomeevent—notinthis situation.You loseweight becauseyour

cellsareinessencestarving.Nutrientscannotenteryourcells,soyourbodyis

malnourished.Yes,evenifyouareeatingplentyoffood,nutrientsandfuelare

unabletogetwheretheyareneeded.

Everyday,peoplearriveatdoctors’officescomplainingoffatigue,frequent

urination, thirst, and sometimes unexplained weight loss. The doctor takes a

blood sample, finds an unusually high level of glucose in the blood, and

diagnosesdiabetes.Thedoctorthenadvisesthepatientthatitisessentialtoget

bloodsugarundercontrol.Anoverlylargeamountofglucosefloodingthrough

the bloodstream day after day can harm the arteries. Left unchecked, it can

damage the heart and the delicate blood vessels of the eyes, kidneys, and

extremities.

Butaswehaveshowninourresearchstudies,theroadtohighbloodsugaris

a two-way street. When you change your diet and make other healthful

improvements,arisingglucoselevelcanfall.Sometimesthechangecanbeso

dramaticthatnodoctorlookingatyouafterwardwouldeverguessthatyouhad

oncebeendiagnosedwithdiabetes.

HowDoctorsDiagnoseDiabetes

Doctorsdiagnosediabetesif:

• Yourbloodglucoselevelis126mg/dl(7.0mmol/l)*orhigherafteran8-hourfast.

• Your blood glucose is 200 mg/dl (11.1 mmol/l) or higher after a 2-hour glucose tolerance

test. This is a test in which you drink a syrup containing 75 grams of glucose, and your

bloodglucosevalueismeasured.

• Your A1Cblood test is6.5 percent orhigher. A1C is atest that reflectsyour blood sugar

controloverthepreceding3 months or so, unlikeabloodglucose test, which will tendto

rise and fall from minute to minute under the influence of foods, physical activity,

medications,stress,andotherfactors.WhattheA1Ctestactuallymeasuresishowmuch

glucosehasenteredyourredbloodcellsandbecomestucktohemoglobin.Ifyouhavehad

a lot of glucose in your blood, a fair amount of it gets into your cells and sticks to your

hemoglobin.

*USmedicallaboratoriesmeasureglucoseinmilligramsperdeciliter(mg/dl).Inmostother

countries,glucoseismeasuredinmillimolesperliter(mmol/l).Asyouwillsee,thesame

unitsareusedincholesterolmeasurements.

DiabetesTypes

Adiagnosisofdiabetes—orprediabetes—meanstheinsulininyourbodyisnot

doing its job adequately. Insulin is a hormone that moves sugar from your

bloodstreamintothecellsofyourbody,amongotherfunctions.Itactslikeakey,

opening a door to the cell, so to speak, and allowing nutrients inside. When

insulinarrivesatthecell’ssurfaceandopensthedoor,glucoseisabletoenter

thecell,whichusesitforpower.

Ifforsomereasonyourbodyisnotmakinginsulin,theresultisrisingblood

glucose levels. Similarly, your blood glucose rises if your cells resist insulin’s

actions—thekeygoesinthelock,butthedoorwillnotopen.

Diabetes comes in three main types, called type 1, type 2, and gestational

diabetes, plus some variants you may need to know about. Let’s look at each

one.

Type1diabetesusuallymanifestsinchildhoodoryoungadulthood.Itused

to be called childhood-onset or insulin-dependent diabetes. In type 1 diabetes,

somethinghasdamagedthepancreas’sabilitytoproduceinsulin,andyouneed

togetitfromanoutsidesource—typicallybyinjection.However,researchhas

revealedagreat dealabout how dietchanges can reducethe risk thatdiabetes

willbringanyseriouscomplicationsyourway,asyouwillseeinChapter3.

Inaddition,weknowmorethaneveraboutthecausesofthedisease,arming

uswithmorepowertopreventit.Thedamagetotheinsulin-producingcellsis

causedbythebiologicalequivalentof“friendlyfire.”Thatis,itiscausedbythe

body’simmunesystem—ourwhitebloodcellsthataresupposedtofightbacteria

andviruses.Thesecellsoughttoprotectyou,butinsteadtheyhaveattackedthe

cellsofthepancreas,destroyingitsabilitytoproduceinsulin.InChapter3,we

willlookatwhattriggersthisprocess.Itmaysurpriseyoutolearnthatfoods—

particularlythefoodsinfantsarefedwithinthefirstmonthsoflife—areleading

suspects.

Whentype1diabetesmanifestsinpeoplewhoarebeyondearlyadulthood,

thetermlatentautoimmunediabetesofadults(LADA)issometimesused.But

thediseaseisstilltype1diabetes.

Type2diabetes used tobe called adult-onset diabetes,or sometimes non-

insulin-dependentdiabetes.About9outof10peoplewithdiabeteshavetype2.

Mostpeople withthisform ofthe diseasestillproduce insulin;theproblem is

thattheircellsresistit.Insulintriestobringglucoseintothecells,butthecells

respond like a door with a malfunctioning lock. In response to these sluggish

cells, your body produces more and more insulin, trying to overcome the

resistance.Ifthebody’sinsulinsupplycannotovercometheresistance,glucose

simplybuildsupinyourblood.

Diabetesdrugsworktocounteractthisproblem:Somemakeyourcellsmore

responsivetoinsulin.Otherscauseyourpancreastoreleasemoreinsulinintothe

bloodstreamorblockyourliverfromsendingextraglucoseintotheblood.

Until now, most diabetes diets have tried to compensate for the cells’

resistancetoinsulin’saction,too.Theylimitedtheamountofsugarinyourdiet.

Theyhavealsolimitedstarch(complexcarbohydrate)becausestarchisactually

madefrommanyglucosemoleculesjoinedtogetherinachain.Duringdigestion,

starchbreaks downto releasenatural sugarsinto theblood. Theidea isthat if

you do not gettoo much carbohydrate at any one time, your cells will not be

overwhelmed with too much glucose. For people on medications, typical diet

planshaveaimedtokeeptheamountofsugarorstarchfairlyconstantfrommeal

tomealandfromdaytodaysotheamountofmedicationrequiredtohelpyour

body process glucose—your daily dosage—can stay the same, too. In short,

thesedietshaveguidedyouonwhat,when,andhowmuchtoeat.

New research has changed everything, however. We can now use diet

changestoinfluenceinsulinsensitivitydirectly.So,asyouwillseeshortly,the

nutrition prescription has been completely rewritten to take advantage of this

newunderstanding.

Gestational diabetes is similar to type 2 except that it occurs during

pregnancy. While it typically disappears after childbirth, it is a sign of insulin

resistance,andthatmeansthattype2diabetesmaybearoundthecorner.With

thesamesortsofstepsthattackletype2diabetes,wecanoftenstopgestational

diabetesfromeverturningintotype2.

Maturity Onset Diabetes of the Young (MODY). Rarely, a genetic

characteristiccancausethepancreastoproduceinsufficientinsulin.Thegeneis

typicallydominant.Theaffectedindividualisverylikelytodevelophighblood

sugars,even thoughhe orshe maynotbe overweightor haveinsulin-resistant

cells.Becausethepancreascontinuestoproducesomeinsulin,insulininjections

maynotbeneeded.Thetreatmentissimilartotype2.

Prediabetesisthetermusedwhen yourblood glucoselevel ishigher than

normal, but not high enough for a diagnosis of diabetes. For most people, it

meansthatyouhaveinsulinresistanceandareonyourwaytodevelopingtype2

diabetes,unlessyoutakestepsnowtoimproveyourhealth,especiallythrough

changesinyoureatinghabits.Thistermapplieswhen:

• Yourfastingbloodglucoselevelisbetween100and125mg/dl(between5.6

and6.9mmol/l).

• Your blood glucose is between 140 and 199 mg/dl (between 7.8 and 11.1

mmol/l)aftera2-hourglucosetolerancetest.

• YourA1Cbloodtestisbetween5.7and6.4percent.

Thegoodnewsisthatthesamestepsthathelppeopletackletype2diabetes

are also effective for helping people with prediabetes to improve, often

decisively.

Insulinismadeinthepancreas,anorganlocatedjustbehindyourstomachthatisaboutthesize

and shape of a TV remote control. In fact, remote control is what the pancreas is all about. It

sendsinsulinintothebloodstreamtotraveltothecellsofyourbodytohelpthemtakeinglucose

fromthebloodstream.Intype1diabetes,thepancreashasstoppedmakinginsulin.Intype2and

gestationaldiabetes, the pancreasis usuallyabletomakeinsulin,but the body’scellsresistits

action.

GENESARENOTDESTINY

Diabetesrunsinfamilies,butdon’ttakethattomeanthatifoneofyourparents

has diabetes, a similar diagnosis has to be your fate as well. You can change

things.

Let’stakealookattype1diabetesfirst.Manychildrenarebornwithgenes

thatmakeitpossibleforthemtodeveloptype1diabetes,butmostofthemnever

do.Infact,evenamongidenticaltwins,whenonetwinhastype1diabetes,the

otherhaslessthana40percentchanceofhavingit.

Whatmakesthedifference,

apparently, is the environment, particularly the foods the child is exposed to

earlyinlife(e.g.,cow’smilk);viralinfections;andperhapsotherfactors.

Genesplayasimilarroleintype2diabetes.Manyyearsbeforediabetesever

manifests, special tests can detectinsulin resistance in young adults who have

inherited a tendency towardtype2 diabetes from their parents. If they eat the

samekindsoffoodstheirparentsdid,theyareverylikelyheadedforadiagnosis.

Abundantevidenceshows,however,thatchangesindietandlifestylecancutthe

oddsthatdiabeteswilloccur.Whenitdoesoccur,dietcandramaticallyalterits

course.

Thepointisthis:Somegenesaredictators,andothersarenot.Thegenesfor

haircolororeyecolor,forexample,reallyaredictators.Iftheycallforyouto

have brown hair or blue eyes, you can’t argue. But the genes for diabetes are

morelikecommittees.Theydonotgiveorders;theymakesuggestions.

Ifourgenescallfordiabetes,wedonotnecessarilyhavetolistentothem.

Wehavemorecontrolthanyoumightimagine.

EATINGPATTERNSFORDIABETES

Ifyouhavediabetes,chancesareyouweregivenprintedguidelinesonwhatto

eatandwhattoavoid.Perhapsyouhavemetwithadietitian,andyoumayhave

been referred to a diabetes class. If you are like many people, you may have

foundyourdiettoughtosustain.

For many years, diets for people with diabetes were designed to provide

basic nutrition while also keeping calorie intake and food choices reasonably

stableoverthecourseofthedayandfromonedaytothenext,asyousawabove.

Theideawasthatifyouhadnocarbohydratesforbreakfastbutthenhadabig

carb-festlaterintheday,yourbloodsugarwouldchangeerratically.Similarly,if

youhadlotsofstarchyfoodsonMondaybutwentlow-carbtherestoftheweek,

your blood sugar would be all over the map, and your medications could not

keepupwithyou.

Thatapproachsoundslogical,butitwasdevisedbeforethecausesofinsulin

resistancewereknownandhasturnedouttobeoflimitedvalue.Manypeople

have trouble sticking with it. Now that we understand more about what is

happening inside your cells to cause diabetes, we can choose foods more

strategically.Thatmeansdietchangesthataresimplerandmoreeffective,asyou

willseeinthefollowingchapters.

The American Diabetes Association now gives a thumbs-up to several

different eating patterns, including vegetarian and vegan diets, the semi-

vegetarian “DASH diet,” low-fat diets, low-carbohydrate diets, and

“Mediterranean diets.” However, we now have good scientific evidence that

allowsustoseewhichdietchangesreallyworkbestoverthelongrun,andsoon

youwillbeputtingthatpowertowork.

DRUGSANDMONEY

Thedietchangesyouwillreadaboutinthisbookarepowerful.Unfortunately,

thepowerofnutritionisneglectedinmanymedicalpractices,andintheprocess,

diabetestreatmentisreducedtoaseriesofprescriptions.

Don’tmisunderstandme.Diabetesmedicationscanbelifesaving.Theycan

reduceyourbloodsugarand,overthelongrun,cutyourriskofcomplications.

Andifdietandlifestylechangesdonotdothejob,itcanbeaseriousmistaketo

forgomedications.Butsomedoctorsandpatientsviewmedicationsastheonly

tools at their disposal. The marketing of pharmaceuticals has so dominated

medicalpracticethatmanydoctorsgivelittlemorethanlipservicetodietand

exercise,whichcanoftenbedramaticallyeffective.

Openanydiabetesjournalandyouwillseeexpensiveadvertisementsforthis

drugandthatdrug.

Ifyouweretoleafthroughthemailthatfloodsdoctors’offices,youwould

see information about medical courses, symposia, and online educational

programs, all paid for by drug companies trumpeting their products. These

companiescaterfulldinnerstoluredoctorstopresentationsaboutoneoranother

applicationoftheirdrugs.Whilemanydoctorsfindsucheventsdistasteful,they

are required to attend medical courses to maintain their hospital or university

affiliations,anddrugcompanieshavecorneredthemedicaleducationmarket.

At the ADA annual meeting, drug company representatives arrive at the

loading dock looking as if they are preparing to put on an enormous political

convention. They erect huge display booths costing hundreds of thousands of

dollars staffed with armies of sales personnel ready to provide gifts, food,

musical entertainment, and trinkets of all kinds, all designed to woo the

cliniciansinattendance.

And, of course, drug companies target consumers directly. Turn on a

televisioninanyAmericancity,andyouwillsoonbeinundatedbycommercials

asking you to speak with your doctor about all manner of medications. They

make diabetes sound almost like fun, and their latest products add to your

modernlifestyle.

You,thedrugconsumer,arestuckwiththebillforallthis.Atypicaldiabetes

pillcontainsafewcents’worthofactivemedication,buttheretailcostisheavily

inflatedbyitsmanufacturer’spromotionalexpensesanditscontinuedeffortsto

findyetanotherpillthatcancarveoutmoreofthemarketshare.

Thediabetes businessis notlimitedto drugs.Patients needtobuy glucose

testing equipment, too. While glucose meters are not terribly expensive,

manufacturerschargeasmallfortuneforthesuppliesthatgowiththem,much

liketheshaving-productcompaniesthatgiveawayfreerazorstosellexpensive

blades.Theteststripsthatfitintoatypicalglucosemetercostabout$1each,and

apersonmightuseanywherefromonetoeightstripsperday.Addupthecosts

ofdoctorvisits,laboratorytests,medication,andglucosemonitoringequipment,

anddiabetesbecomesaphenomenallyexpensivedisease.

It is my hope that as the power of nutritional changes is more fully

appreciated, the commercial aspects of diabetes will take a backseat. The US

government has already invested in research on diet and diabetes, and that

investment will continue to pay important dividends. We must also turn our

attentiontoputting whatwehavelearnedabout nutritiontowork. Thatmeans

encouraging doctors to focus on diet first, pushing insurers to cover dietetic

counseling for patients and their families, educating parents about nutritional

approachestohelp preventtype1 diabetesintheirchildren, andworkingwith

schools to serve healthful meals so children are not sent down the road to

overweight anddiabetes, as a great manycurrently are. These measurescould

controltheso-calleddiseasesofaffluencefarmoreeffectivelythandoctorsare

able to at present, dramatically reducing the need for medications in the first

place.

Eachpersonwithdiabeteshasauniqueabilitytohealandreturntohealth.

Thisabilitydiffersfromonepersontothenext,butinourstudies,wehavenot

seenage,weight,oranyotherfactortobeabarriertoimprovement.

The remainder of this book will show you what I believe to be the most

powerfuldietaryapproachtodiabetesthatiscurrentlyknown.

Thepassageofglucosefromthebloodstreamintotheurineledtothetechnicalnamedoctorsusefor

diabetes:diabetesmellitus.DiabetescomesfromaGreekwordmeaning“topassthrough,”andmellitusis

theLatinwordfor“honey”or“sweet.”

CHAPTER2

ReversingType2Diabetes

Remarkably, my research has shown that it is possible to reverse diabetes—to

decreasebloodsugar,medicationdoses,andtheriskofcomplications—andthis

chapterwill show youhow,using surprisingly simplediet changes.I willalso

share some surprising new findings about the causes of type 2 diabetes—

changesinsideyourbody’scellsthatcanbedetectedyearsbeforediabetesstarts.

Evidencesuggeststhatswitchingtoahealthierdiethasapowerfulinfluenceon

theworkingsofyourcells,asyouwillsee.

Alldoctorsanddietitiansrecognizethatifyouhavediabetes,yourbodydoes

not process sugar very well, which is to say that the amount of sugar in your

bloodstreamistoohigh.Researcherslearnedlongagothatifitstayshigh,you

areatriskformanyhealthproblemsdowntheroad.

Toloweryourbloodsugar,mostmedicalprofessionalsarelikelytoprescribe

adietthatincludesverylittlesugar.Theywillalsoaskyoutolimitstarchyfoods

—such as bread, potatoes, rice, and pasta—because in your digestive tract,

starchbreaksaparttoreleasesugar(thatis,glucose).Itseemstomakesense—if

your body cannot handle sugar, you have to be careful about eating too much

sugarandanythingthatturnsintoit.Yourmedicalteamwillalsoencourageyou

to spaceout your intakeof starches and sugarsthroughout the day—and from

onedaytothe next—sothat itstays fairly evenover time.Diabetes diets also

generallycutcaloriestohelpyouloseweightandlimitcertainfatstoreducethe

risk of heart disease and other complications. That, in a nutshell, is a typical

“traditional”diabetesdiet.

Itiscertainlylogical,andsomepeoplegreatlybenefitfromfollowingit.The

problemisthatformostpeople,thissortofdietchangehasonlyaverylimited

effect.Weightlossisusuallymodest,andthedietalonetypicallyisnotenough

tobringbloodsugarundercontrol.

Soonerorlater, youandyourdoctor arelikelytodecide thatthe“diabetes

diet”isnothelpingverymuch,andyourdoctorwilladdvariousdrugs.Youmay

needone,two,oreventhreedifferentoralmedications.Eventually,yourdoctor

mayconsideraddinginsulininjections.Andbecausemanypeoplewithdiabetes

also have high blood pressure or high cholesterol levels, doctors often add

medicationstotackletheseproblems,too.Insteadofhelpingyoureduceoravoid

medications, the diet seems to be a stepping-stone on the way to an ever-

increasinglistofdrugs.

Thefirstglimmerthattheremightbeabetterwaycamefromalookatthe

prevalenceofdiabetesaroundtheworld. Largepopulationstudiesshowed that

diabetes wasrare in Japan,China, Thailand, and otherAsian countries. Itwas

similarlyrareinpartsofAfrica.

These studies also showed something else: People in countries where

diabetes was uncommon were not following anything like a “diabetes diet.”

Theydidnotavoidcarbohydrates;theyatestarchyfoodseveryday.InAsiaand

Africa, rice and other grains, starchy vegetables, bean dishes, and noodles are

staples.Infact,researchersfoundthatpeopleinthesecountriesateconsiderably

more carbohydrates than North Americans or Europeans do, yet diabetes was

relativelyrare.Sowereweightproblems.Whileobesityisfoundinmorethan30

percentofAmericanadults,itoccurredinlessthan1percentofJapaneseadults

followingatraditionaldiet.Heartdiseaseandseveralformsofcancerwererare,

too.LongevityamongJapaneseadultswasbetterthanthatofNorthAmericans

orEuropeans.

That is, until they moved to Vancouver—or Seattle, Chicago, Atlanta, or

Washington,DC. Fora Japanese adult,a moveto NorthAmericadramatically

increasedtheriskofdiabetes.Heartdisease,obesity,andotherproblemsbecame

muchmorecommon,too.

Now, ifyouareworrying thatIamgoing toask youtoadopta traditional

Japanesediet,relax.That’snotabadidea,butitisnotwhatthisbookisabout.I

raise this international comparison simply to make an important point:

Carbohydrates do not cause diabetes. And a diet that focuses on keeping

carbohydrates out of your diet is not a powerful way to manage—let alone

reverse—thedisease.Ifanything,healthycomplexcarbohydrateshelppreventit.

Think about what happens when an Asian man or woman switches to a

Western lifestyle. Hamburgers, fried chicken, cheese, and other Western fare

come into the diet, while rice and noodles are gradually forgotten. The diet

becomes fattier and much higher in protein, while carbohydrate-rich rice and

noodlesandotherstarchyfoodsfallbythewayside.

Tragically, thatis exactlywhat ishappening. What’smore, Asianmen and

womenneednotleavehomeforthesechangestooccur.McDonald’shascome

tothem;BurgerKing,KFC,andotherWesterneatinghabitshavealsoinvaded

Asia.Meat,cheese,andothergreasyfoodsaredisplacingriceandvegetables.

AstheJapanesediethasbecomeWesternized,theprevalenceofdiabeteshas

exploded. In studies of adults in Japan over age 40, diabetes prevalence was

between 1 and 5 percent prior to 1980. By 1990, it had gone up to 11 to 12

percent.

Statisticalprojectionssuggestitwillriseevenfurther.Itturnsoutthat

the genes that allow diabetes to occur are surprisingly common among the

Japanese,butaslongastheystucktotheirrice-basedtraditionaldiet,thedisease

wasmostlyheldincheck.Thediabetesgeneslaydormant,likeseedsondrysoil.

Once rice fell out of fashion and Western eating habits took hold, the genetic

traitsstartedtoshowthemselves.

So,ifpeopleinAsiaorAfricawhoeatlotsofcarbohydrateshaveverylittle

diabetes,andifthediseasebecomesmoreandmorecommonascarbohydrates

are excluded from the diet, researchers have had to conclude that a high-

carbohydratedietisnotthecauseofthedisease.Infact,theculpritseemstobe

lurkinginourWesterndiets.

Theinescapablefactisthattheproblemisnotcarbohydrates(thatis,sugar

and starch). The problem is in how the body processes them. If we can repair

your body’s ability to absorb and use carbohydrates, not only can you enjoy

healthy carbohydrate-rich foods without worry, but diabetes itself ought to

improve—perhapsevengoaway.

AlookinsideyourbodywillshowyouwhatImean.

ALOOKINSIDEYOURBODY

Your pancreas, an organ in your abdomen, produces insulin. As you know by

now, insulin is a hormone, and the pancreas sends it into your bloodstreamto

travel to the various cells of the body. Like a key sliding into a lock, insulin

attaches to a receptor on the cell’s surface and causes the cell membrane to

permit glucose to enter. Insulin does the same thing for the next cell, and the

next,andthenext.Itattachestoareceptoronthecell’ssurface,opensthedoor,

andushersglucosein.

Intype2diabetes,thissystemdoesnotworkproperly.Yourpancreasmakes

insulin, and insulin travels to each cell, but when it arrives, it has trouble

openingthedoor.Itisasifthelockhassomehowbecomejammed,andthekey

nolongerworks.Thisisinsulinresistance.Yes,theinsulin“key”isthere,butit

hastroubledoingitsjob.Glucosecannotgetintothecells,anditbuildsupinthe

bloodstream.

Imaginetheworkingsofalockonatypicaldoor.Whatifsomeonewereto

jamchewinggumintothelock?Thereisnothingwrongwithyourkeyandreally

nothingwrong withthelock exceptthatit isnowfilledwithgum.Tomakeit

workagain,weneedtocleanitout.

Thenewapproachtodiabetesisbasedoncleaningoutyourbiologicallocks.

Ourgoalistohelpyourinsulin“key”workthewayitissupposedto.

THENEWDIABETESDIET

Asfarbackastheearly1900s,researcherswereadjustingpeople’sdietstotryto

improve insulin sensitivity.

2, 3

 Over the years, many—like me—have been

inspired by the fact that foods that are commonly eaten in Asia or Africa

somehowhelppreventdiabetes.

In1979,researchersattheUniversityofKentuckystudied20menwithtype

2diabetes,allofwhomhadbeentakinganaverageof26unitsofinsulinperday.

The experimental diet included plenty of vegetables, fruits, whole grains, and

beans,soitwashighinfiberandcarbohydrate.Thedietwasnearlyvegetarian,

withverylittleanimalfat—infact,verylittlefatofanykind.

Afterjust16daysontheprogram,morethanhalfofthemenwereableto

stoptakinginsulinentirely,andtheirbloodsugarlevelswerelowerthanbefore.

For the remaining men, insulin doses were cut dramatically. That was an

amazingandrapidresult.Butthestudywasshort,andtheparticipantslivedon

theresearchwardforitsduration.Itwasunclearwhetherasimilarresultwould

beseeninpeoplelivingontheirownandpreparingtheirownmealsandwhether

itwouldbesustainedoverthelongterm.

A study conductedatthe University of California, Los Angeles—197men

enrolledina3-weekdietchangeandexerciseprogram—showedmuchthesame

thing.Ofthisgroup,140wereabletodiscontinuetheirmedications.

Thatwasa

greatresult,anditoccurredveryquickly.Thestudy’slimitationfromourpoint

ofviewwasthatitcouldnotseparatetheeffectsofdietfromthoseofexercise.

Both are important, of course, but if we want to track down the best diet for

diabetes,itisimportanttokeepeverythingelseconstantwhilethedietisbeing

tested.

Several years ago, my researchteambegan a series of studies to see what

dietalonecoulddo.Wetestedadietthatfocusednotonlimitingcarbohydrates

but rather on getting as much fat off the plate as possible. We thought if we

coulddothat,perhapswecouldcleanoutthe“lock”mechanismthatopensthe

celldoors.

We began with a small pilot study, which I mentioned briefly in the

Introduction. Most of the participants were surprised to see rice, pasta, sweet

potatoes,andbeansonthemenuandevenmoresurprisedthatthedietdidnot

limit carbohydrates at all. No matter how long they had had diabetes or how

nervoustheyfeltabouttheideaofputtingcarbohydratesbackontotheirplates,

weputnolimitoncarbsatall.

There was also no limit on portions. Most of our participants were

overweight,butevenso,wedidnotaskthemtolimitportionsorcutcalories.

Whatwezeroedinonwasfat.Weaimedtocleanallthegreaseoutofthe

participants’ diets. So, instead of bacon and eggs for breakfast, they had to

choose from old-fashioned oatmeal, halfa cantaloupe, or whole grain toast. If

theyhadchiliforlunch,itwasveggiechili.Insteadofpastatoppedwithmeat

sauce,theygotmeatlessmarinara.Forthedurationofthestudy,weaskedthem

tosetasideanimalproductscompletelyandsticktovegetarianfoods.

Needless to say, if there are no animal products in the diet, there is not a

single drop of animal fat. We kept the use of vegetable oils as minimal as

possible, too. And, in order to isolate the effects of the diet, we asked the

participantsnottoaltertheirnormalactivitypatterns;noonewastoaddexercise

totheregimen.Now,exerciseisanimportantpartofanyhealthylifestyle,and

ordinarilywewouldstronglyencourageit.Butthiswasatestofthedietalone,

andforscientificreasons,exercisewasnottobepartofit.

Attheendofthestudyperiod,everyone weighedin.In just12 weeks,the

averageparticipanthadlost16pounds.Theirfastingbloodsugarhaddropped28

percent. Two-thirds of the participants on diabetes medications were able to

reduce or discontinue them in that short period of time.

 All this occurred

withoutanylimitsoncalories,portions,orcarbohydratesandwithoutexercise.

These effects were significantly greater than those seen in a control group

carefully following the diet guidelines of the American Diabetes Association

(ADA).

Thatwasimpressive.Butwhy didithappen? Howdoes adietthat givesa

green light to pasta, rice, and all the other foods that people with diabetes

thought they had to live without—and one that completely disregards calories

and avoidsexercise—cause bloodsugar to plummetand weightto easily drop

away?

To answer that question, we designed another study. This one included a

groupofwomenwhoweremoderatelyorseverelyoverweightbutdidnothave

diabetes. Once again, we zeroed in on animal fat and vegetable oils. Our

participantssetanimalproductsasideandkeptoilstoabareminimum.Andthey

werefreetoimplementthedietguidelinesintheirownway,whethertheyateat

homeorateout,soitwasagoodtestofhowthedietwouldworkinreallife.For

one person, eating out might have meant mushroom stroganoff with steamed

vegetables;foranother,itmighthavebeenvegetablesushiwithmisosoupand

salad.Aslongastheyavoidedanimalproductsandkeptoilstoaminimum,they

werefreetoshapetheirmealstotheirliking.

Forcomparison,weincludedacontrolgroupwhosemembersfollowedwhat

youmightthinkofasatypicalcholesterol-loweringdiet.Itcutbackonredmeat

whileemphasizingpoultryandfishalongwithplentyofvegetables,fruits,and

wholegrains.

The results were quick and impressive. The vegetarian group participants

lost about a pound per week; after 14 weeks, they had lost an average of 13

pounds,comparedto8poundsforthecontrolgroup.

bynow,it wasnosurprise thatthisdiet causesweightloss, butwewent a

step further. We sent our participants to the laboratory for a glucose tolerance

test,whichallowedustomeasurehowtheirbodiesrespondedtosugarandhow

well their bodies’ insulin was working. Each participant swallowed a dose of

sugary syrup, and we took blood samples every half hour to measure rises in

bloodsugarandinsulin.From theselaboratorydata, wewere ableto calculate

each woman’s insulin sensitivity and track how it changed as the study

progressed.

The results were remarkable. The tests showed that our participants were

physicallychanging.Basedontheirlaboratorymeasurements, itwas clearthat

theirbodies’cellswerebecomingmoreandmoresensitivetoinsulin.Bythe14-

weekpoint,theirinsulinsensitivityhadimprovedby24percent.Inotherwords,

something about the diet reactivated their natural insulin’s ability to open cell

doorstoglucose.Whatthatmeans,ofcourse,isthatthedietwasaddressingthe

fundamental problem we see in type 2 diabetes: It was helping glucose get to

whereitbelonged.

Based on these and other studies, the National Institutes of Health—the

researchbranchoftheUSgovernment—decidedtofundanewstudy.

Working

with me on the project were researchers from George Washington University

SchoolofMedicineandtheUniversityofTorontoanddietitiansandphysicians

working with the Physicians committeefor Responsible Medicine, a nonprofit

organizationIfoundedin1985.

Thestudyincluded99peoplewithtype2diabetes.For22weeks,49ofthem

followed a diet that was similar to those we had tested earlier. The diet was

vegan—meaningthatitincludednoanimalproductsatall—andwaslowinfat.

Also,whileweplacednolimitsontheamountofcarbohydratesourparticipants

could have, we encouraged everyone to be selective about the kinds of

carbohydratesthey ate.Instead ofwhite bread,we encouragedthemto choose

ryeorpumpernickel.Insteadofbakingpotatoes,wefavoredsweetpotatoesand

yams. The remaining 50 participants followed a diet based on the ADA

guidelines.Onceagain,werestrictedexercise.

Whatwashappeningwasthatthediethadmadetheircellsmoresensitiveto

insulin’saction,sotheywereabletotakeinnutrientsmorequickly.Glucosegot

outofthebloodandintothecells,wheremoreofitcouldbeburnedup,soto

speak.Thesecaloriesarereleasedasbodyheatratherthanbeingstoredasbody

fat.Scientistscallthisthethermiceffectoffood,anditprovidesa smallextra

edgeforweightloss.

Overtheensuingweeks,manyparticipantsfoundtheirbloodsugarfallingto

the extent thatthey had to cut back on theirdiabetes medications. That was a

happy outcome, but it was not our goal. In fact, we were trying to keep

medicationsunchangedasmuchaswecouldsowecouldisolatetheeffectofthe

diet on their blood sugar. The combination of the diet and the blood sugar–

loweringdrugswassopowerful,however,thatmanyparticipantshadtoreduce

theirdosesordiscontinuemedicationsaltogethertokeeptheirbloodsugarfrom

droppingtoolow.

To really gauge what the diet could do, we looked at those participants

whose medications had stayed constant and how the diet affected A1C—the

principalgaugeofbloodglucosecontrol.TheADAdiethadreducedA1Cby0.4

percentage point—a good change. But the vegan diet was three times more

effective. It had reduced A1C by 1.2 percentage points (the average person’s

valuefellfrom8.0to6.8percentduringthe22-weekstudy).Thatisastronger

effectthanisseenwithatypicaldiabetesmedication.Thevegandietalsoproved

highlyeffectiveinreducingbodyweightandcholesterol.

Toputallthisinperspective,thelandmarkUKProspectiveDiabetesStudy

showedthat a1-point dropin A1Cfor peoplewith type2 diabeteslowers the

riskofeyeorkidneycomplicationsbyabout37percent.

Thisistheeffectof

just the A1C drop without considering the ability of the diet to also reduce

cholesterolandbloodpressure.

Inthenextchapter,Iwillshowyouhowyoucantestthisdiettoseewhatit

candoforyou.Butlet’slookabitcloseratthesciencebehindthisapproach.

TOWARDTHEPERFECTDIET

Settingasideanimalproductsandkeepingoilyfoodstoaminimummaysound

challenging,butourparticipantscommonlyreportedjusttheopposite.Oneman,

Walter, said, “I’m amazed at how easy it was to adapt to this diet. And I feel

great.Within2months,Ilost20pounds.Andthemoreamazingthingtomeis

thatmyglucoseaverageshavefallenby30to40points.”

For Mark, the change was “an adventure. I tried new restaurants, new

recipes,anddifferentfoodsIwouldneverhaveeatenbefore.Mymaingoalwas

toloseweight,andI’velostagood30poundssofar.WhenIstarted,myfasting

bloodsugarwas260to360.Anditdroppedlikearock.NowI’mbetween130

and135.AndIdon’tgettiredintheafternoonlikeIusedto.”

Nancy agreed. She felt totally adjusted to the diet within about 30 days.

“Andwithin5monthsofmakingthechange,”shesaid,“mybloodsugarfellso

muchthatIwasabletostoponeofmymedications.Ihavemuchmoreenergy

andreallyfeeltremendous.”

Iwillwalkyouthroughthedietstepbystep.Ifitsoundslikeaveryhealthful

diet,itcertainlyis—andnotjustforcontrollingbloodsugar.

In1990,DeanOrnish,MD,ayoungHarvard-trainedphysician,discovereda

remarkablefeatureofalow-fat,vegetariandiet.Hetestedthedietinindividuals

withheartdiseaseand addedother healthylifestylechanges—regularexercise,

stress modification, and smoking cessation. Because the diet contained no

animal products, it had no cholesterol at all and very little fat. After a year’s

time,eachpatienthadaspecialx-rayoftheheartcalledanangiogram,andDr.

Ornish’steamcomparedtheresultswithangiogramsdoneonthesamepatients

at the beginning of the study. The results made medical history. The patients’

coronaryarteries,whichhadbeenblockedbyyearsofpoordiet,wereactually

starting to open again. The difference was clearly visible in 82 percent of the

patients after 1 year. This occurred without surgery or drugs—even without

cholesterol-loweringmedication.

12,13

Other researchers have shown that this same sort of diet change reduces

blood pressure. Apparently, eliminating animal fats reduces the viscosity

(“thickness”)oftheblood.Thatis,thebloodbecomeslesslikegreaseandmore

likewater,soiteasilyflowsthroughthearteries,causingbloodpressuretofall.

Blood pressure is also reduced by the potassium in vegetables and fruits, and

othercharacteristicsofplantfoodsaugmentthisbenefit.

Vegetariansareslimmer,too.Theaveragepersonwhoembracesavegetarian

dietlosesabout10percentofhisorherbodyweight.

Thesechangeswouldbewelcomedbymostofus,butifyouhavediabetes,

they can be lifesaving. This is because, as you saw in Chapter 1, persistently

highbloodsugarcanattackthebloodvesselsofyourheart,eyes,kidneys,and

legs. What kills most people who have diabetes (that is, those who have not

madethedietchangesyouarereadingabout)isdamagetotheirhearts.Adiet

that reverses that process—turning the clock backward on heart disease,

reducing blood pressure, and trimming weight—is powerful medicine for

everyonewithdiabetes,whethertype1ortype2.

Imagine if your eyes were damaged by the disease. An ophthalmologic

surgeon,laserinhand,wouldcarefullytrytorepairyourtenderretinas.Butwhat

iffoodscouldhelpavertthisdamageinthefirstplace?Adietchangethatbrings

your blood sugar under control, brings your blood pressure down, and helps

rejuvenateyour arteriesgivesa measureof respitetothe tinybloodvesselsin

youreyes.Itdoesthesameforthetinyvesselsthatmakeupthefilteringunitin

your kidneys, making it less likely that you will ever need dialysis. And of

course,itworkspowerfullyinsidetheheart.

Now, donot misunderstandme. Iamnotsuggestingthat youshould forgo

neededmedicaltreatmentsandrelyondietalone.Butadietchange—ifitgoes

farenoughandbeginsearlyenough—canrevolutionizeyourhealth,dramatically

cutyourriskofcomplications,andevenreversethesecomplicationstoadegree.

INSIDETHECELL

In discussing type 2 diabetes, I have described each cell of the body as being

rather like a gummed-up lock. Research has shown this analogy to be

surprisinglyapt.Indeed,insulin’sabilitytoworkisblockedbytheaccumulation

ofsomethingwithinthecells:notgum,butfat.

In the February 12, 2004, issue of the New England Journal of Medicine,

YaleUniversityresearchersreportedanamazingdiscovery.

Theytestedyoung

adultswhoseparentsorgrandparentshadhadtype2diabetes.Allwerethinand

healthy, and none had diabetes at that point. But some were insulin resistant,

meaningthatwhentheyweregivenatestdoseofglucose,itbuiltupmorethan

itshouldhaveintheirbloodstream.Theresearchersfoundoutwhy:Insidetheir

musclecellsweretinyamountsoffat,fatthatinterferedwithinsulin’sabilityto

work.Theirbodiesmadeinsulinnormally,anditreachedtheirmusclecellswith

noproblem.Onceitgotthere,though,itdidnotworkproperly.Themusclecells

simplycouldnotfullyrespondtoinsulinbecausetheycontainedbitsoffat,like

gumjammedinalockrenderingakeyuseless.

Howdidthisfatgetthere?Well,musclecellsnormallystoreatinyamount

of fat, which provides an energy source for physical activity. The amount is

normallyquitesmall,andthefatsimplywaitsforthatdaywhenyouaremuch

moreactivethanusualandneedabitofextraenergy.Forsomereason,inthese

young people, fat had built up much more than it should have—to levels 80

percenthigherthaninotheryoungpeople.Thefatbuilduphadreachedthepoint

where it was gumming up the lock. That is, it was interfering with the cell’s

abilitytorespondtoinsulin,andthatmeantthatdiabeteswasverylikelyintheir

futureunlesssomethingchangedinamajorway.

I should emphasize that the fat inside your cells is different from the fat

aroundyourwaistline.Evenifyouarequiteslim,youmaystillbeaccumulating

fat within your muscle cells. The participants in the Yale study were slim,

averaging only 141 pounds. They were young and healthy. But just as young

peoplewhosmokearesetting thestageforcancerdecadeslater,young people

whoaccumulatefatinsidetheirmusclecellsarepavingthewayfordiabetes.

Untilnow,diabetesdietshavenotbeendesignedtoalterwhatgoesoninside

thecells.Instead,theyhavebeendesignedtocompensatefortheproblem,soto

speak. Because your cells cannot handle glucose—that is, insulin has trouble

getting glucose into them—the diets limit sugars and foods that contain

carbohydrate, because when carbohydrate is digested, it releases sugars. But

whatifachangeindietcouldactuallyalterthefatbuildupwithinthecellsand

reversethetrendtowardgraduallyworseninginsulinresistance?

Ibelieve thisis exactlywhat wecan do—exactlywhatyou willdo as you

makethedietchangesdescribedinthisbook.Butfirst,afewmoredetailsfrom

insidethecells.

Normally, insulin attaches to receptors on the cell’s surface and signals the cell membrane to

allowglucosetoenter.However,iffat,calledintramyocellularlipid,accumulatesinsidethecell,it

interferes with insulin’s intracellular signaling process. Tiny organelles, called mitochondria, are

supposedtoburnfat,andtheirfailuretokeepupwiththeaccumulatingfatmaybetheoriginof

type2 diabetes. Luckily, evidence showsthatdietchangescanreducethe amount offatinside

thecell.

TINYFURNACESTHATBURNFAT

Thereisatermforthetinybitsoffatthatbuildupinsidemusclecells.Scientists

call them intramyocellularlipids (intra- means “inside,” myo-is “muscle,” and

lipidis“fat”—literally,fatinsidemusclecells).Asyouhaveseen,thesetracesof

fatstartaccumulatingmanyyearsbeforediabetesmanifests.

Let’sgoonestepfurtherandlookathowthefatbuildsup.Yourcellshave

microscopic“furnaces”or“burners”thataresupposedtometabolizebitsoffat

and convert it into energy. If all is operating normally, fat enters the cell and

thesetinyburnersuseitup.Theseburnersarecalledmitochondria,andtheyare

responsible for turning fat or other fuel sources into energy to power your

musclecells.Ifyouaresteadilyaccumulatingfat,thatisasignthatyourburners

—yourmitochondria—arefallingdownonthejob.

Intype2diabetes,theproblemappearstobetoofewmitochondria.Thatis,

peoplewithtype2diabeteshavefewermitochondriathantheyneedtoburnup

theaccumulatingfat.Iftheyhadmoreoftheselittle“furnaces”insideeachcell,

thingswouldbeverydifferent.

Surprisingly enough, it may be that the number of mitochondria you have

dependsonwhatyoueat.Letmedescribeasecondresearchstudy.

At Pennington Biomedical Research Center in Baton Rouge, Louisiana,

researchers studied 10 young men. They averaged just 23 years of age; were

reasonably trim, averaging 174 pounds; and were healthy. The researchers put

themonahigh-fatdietthatdrewabouthalfitscaloriesfromfats.

Thisismuch

morefatthanyouwouldwanttohaveinyourdiet,butitisnotfardifferentfrom

whatmanypeopleactuallyeat.Afterjust3daysonahigh-fatdiet,themenhad

accumulatedsignificantlymoreintramyocellularlipids,sothefirstlessonofthis

studywasthatfatbuildsup quickly.Dependingon thefoodsyou eat,you can

packfatintoyourcellssurprisinglyrapidly.

Thentheresearcherstestedthegenesthatproducemitochondria.Justasyou

havegenesinyourcellsthatallowyoutomakebones,hormones,skin,hair,and

alltheotherstructuresofyourbody,youalsohavegenesthatserveasblueprints

formitochondria.Itturnedoutthatthefattyfoodsthesevolunteersatedidmore

thanjustpackfatintotheircells;theyactuallyturnedoffthegenesthatwould

help burn fat. The genes that produce mitochondria were in fact partially

disabled.Itwasasifthemen’sbodiesweretryingtoavoidburningthefatthey

hadeatensotheycouldsaveitinsidethecellsforfutureuse.

Imaginewhatthis means:You have eatenfatty foods and,as a result,tiny

bits of fat have accumulated in your muscle cells. This fat interferes with the

normal workings of the cells, including their ability to respond to insulin. If

insulinisunabletowork,glucosecannotgetintothecells,anditbuildsupinthe

bloodstream. Then, those fatty foods actually seem to disable your genes that

wouldproducethemitochondriayouneedtoburnupthisaccumulatingfat.Your

abilitytoeliminatefatinsideyourcellsseemstobesloweddownwhenyoueat

fattyfoods.

Letmespeculateaboutwhyallthisoccurs.

Yourbodychemistrybegantotakeshapemanythousandsofyearsago,long

beforefast-foodrestaurantsandconveniencestoresevergottheirfirstshipments

ofcheeseandfryergrease.Ourhumanancestorsdidnotfindfattyfoodsgrowing

ontrees—oratleastnotmanyofthem.Ontherareoccasionswhentheyatefatty

foods—meat, eggs, nuts, or avocados, for example—theirbodiesmay actually

have tried to save some of the fat from these foods in case they needed it to

powertheirmusclesorfoodbecamescarce.Thus,itwouldnotbesurprisingifa

suddeninfluxoffatinthemusclecellssignalsthemtoturnoffthefat-burning

mitochondriaandsavethefatforfutureneeds.Today,ofcourse,thatisthelast

thing we want. We want to power up our mitochondria—turn on those little

furnacestoeliminatefat.

Well, canyou get rid ofthis fat? Let’s sayyou stopped eating fattyfoods.

Wouldintramyocellularlipidstarttodisappear?

Letmesharetheresultsofastartlingexperiment.AtCatholicUniversityin

Rome,Italy,eightpatientsunderwentgastricbypasssurgery.

Theoperationis

commonly done as a last-ditch treatment for massive obesity, and for good

reason.Whatitinvolvesisthis:Thestomachisstapledsothatonlyatinypouch

aboutthesizeofaneggislefttoreceivefood.Thentheintestineiscutintwo.

Thefirstpartoftheintestinesimplyliesunused,whilethelowerportionofthe

small intestine is attached directly to the tiny stomach pouch. In this way, the

patientcannoteatmuchfood,andthereismuchlessintestineavailabletoabsorb

thenutrientsfromwhateverfoodiseaten.

After the procedure, the patients were essentially starving. They could eat

verylittle foodat anygiven meal,and anyfats theyate werepoorly absorbed

because the first part of the small intestine, which is where fats are absorbed,

wasnolongerconnectedtothestomach.

Asyoumightimagine,theylostweight,droppingfromanaverageofmore

than300pounds(137kg)to229pounds(104kg)inthefirst6months.Thatis

notunusualaftersuchdrasticsurgery.Whatwasstrikingwastheeffectontheir

cells.Thefatinsidetheirmusclecells—theirintramyocellularlipid—droppedby

87percent.Andeventhoughtheywerestilloverweight,theirinsulinresistance

hadlargelydisappeared.

Iamnotrecommendingthatyouhavethisprocedure.Iampresentingthese

findingstomake acriticallyimportantpoint:The fatinsideyourcellsis nota

permanentfixture.Iftheinfluxoffatstops,thefatinsidethecellsdissipates,and

whenthathappens,thecellsstarttoregaintheirnormalfunction.

Surgeryisadrasticsolution,buttheItalianresearchersalsotestedwhethera

low-caloriedietwithoutsurgerycoulddepleteintramyocellularlipid—anditdid.

Followinga1,200-caloriedietfor6months,thepatientslostabout30poundson

average and eliminated about 8 percent of the fat inside their cells. Now, that

modestresultcamefromadietthatfocusedjustoncuttingcaloriesratherthan

oneatingparticulartypesoffood,whichwillbethefocusofthisprogram.The

nextstepistomakethedietmorepowerfulsoitworksalittlemorelikesurgery,

withoutalltheobviousrisksofanoperation.

Let’sgoastepfurther.AtImperialCollegeSchoolofMedicineinLondon,

researchers studied a group of individuals following a vegan diet. They

comparedtheparticipantstootherswhoweresimilarinageandbodyweightbut

were not following a vegan diet.

 When the researchers measured the

intramyocellular lipid in each participant’s calf muscles, they found it was 31

percent lower in the vegans than in the omnivores. It looks as if there is

somethingaboutthedietthathelpspreventfatbuildupincells.

Thesestudiesshow—loudlyandclearly—thattheaccumulationoffatinthe

cellsandalltheproblemsitcausesarenotsimplyamatterofgenes.Genesdo

play a role, but these effects are very much a matter of diet, too, and it can

changedramatically.

InPart2, you will see how to select foods to address this problem in the

mostpowerfulwaypossible.

Thestudyturnedupanotherparticularlyremarkablefinding.InalaboratoryatgeorgeWashington

University,wemeasuredtheparticipants’metabolism—howfasttheirbodiesburnedcalories.Thiswas

donebymeasuringhowmuchoxygentheyconsumedminutebyminuteandhowmuchcarbondioxidethey

producedafterbeinggivenatestmeal(twocansofastandardliquidformula).

After14weeksontheexperimentaldiet,itwasclearthattheparticipantshadasignificantincreasein

theirafter-mealcalorieburn;theirafter-mealcalorie-burningspeedincreasedby16percent.

CHAPTER3

ARevolutioninType1Diabetes

Ifyouhavetype1diabetes,thedietchangesyouwillsoonlearnaboutcanbe

lifesaving. No doubt you have heard that type 1 diabetes increases the risk of

heartproblemsandothercomplications.Whenyoureallytakecontrol,however,

alltheserisksplummet.

Researchhasproventhatyouarenotpowerlessagainstthecomplicationsof

diabetes.Thereisalotyoucandotoprotectyourself.

The Diabetes Control and Complications Trial did it with medication. The

studywassponsoredbytheUSgovernmentandincluded1,441peoplewithtype

1 diabetes. Some of the participants took insulin once or twice daily, as is

common practice. The remaining participants were asked to follow a more

intensiveprogram.Theytookinsulinthreeorfourtimesdaily,eitherbyinjection

or viaaninsulin pump. They checkedtheir blood glucose several timesa day

and adjusted their insulin doses accordingly. Over 17 years of follow-up, the

extracaretheseindividualstookpaidoffdramatically.Carefultrackingofblood

sugar and medication adjustments lowered the risk of heart problems by 50

percent.

Also, although people with diabetes are at risk for eye problems, careful

blood glucose control reduced that risk by 76 percent compared to people on

traditionalmedicaltherapy.Itcuttheriskofkidneyproblemsby39percentand

reducedtheriskofneuropathyby60percent.

The study treatment involved medication rather than diet, but it proved a

vitallyimportantpoint.Manypeople hadimaginedthatdiabetescomplications

are simply inevitable; this study showed otherwise. Gaining control over your

blood glucose makes an enormous difference. Now, with type 1 diabetes, you

will need to use insulin to achieve that goal. But diet and exercise offer

additionalpowerthattoofewpeopletakeadvantageof.Anddietisthefocusof

thisbook.

Also,itisimportanttounderstandthatbloodsugarcontrol—asvitalasitis

—isjustonepartoftheequation.Yourriskofdevelopingproblemswithyour

heart, kidneys, eyes, or extremities also depends on your blood pressure,

cholesterol levels, and other factors. The goal now is to adjust your diet to

controlall ofthese tothe extentthatwe can,adding medicationsas necessary

accordingtoyourdoctor’sadvice.
TOWARDANOPTIMALLIFESTYLE
Intype1diabetes,yourgreatestriskistoyourheartandbloodvessels.Ifyoudo
nothing, cardiovascular disease lies in wait. In fact, it strikes the majority of
people with type 1 diabetes. We now have a better understanding than ever
beforeabouthowtousedietandlifestylechangestoprotecttheheart,notonly
forpeople withdiabetes butfor anyone.Chapters4and5 will cover how and
whattoeatingreatdetail,andChapters12and13willdiscussthecomplications
head-on.Inthemeantime,herearethekeys.
A healthy diet. Follow the diet steps outlined in the next chapter. These
practiceseliminatecholesterolandanimalfat,keepfatsingeneralverylow,and
guide you away from sugar and refined carbohydrates and toward healthy
complexcarbohydrates.
Asyouwillsee,thereisaspecialadvantagetoavegetariandiet,orIshould
say a vegan diet—meaning a menu that includes no animal products at all.
Dietarycholesterolisfoundonlyinanimalproducts.
*
Animalproductsalsotendtobehighinthesaturated(“bad”)fatsthattendto
causeyourbodytomakeadditionalcholesterol,aneffectthatisactuallymuch
greater than eating cholesterol itself. A plant-based diet eliminates these
problems.Ithasanothermajorbenefitaswell:Itderivesitsproteinfromplants
rather than from animal products. Research studies have shown that among
peoplewithanydegreeof kidneydamage, animalproteinincreases theriskof
further kidney deterioration.
3
 On the other hand, healthy beans, grains, and
vegetablesarejustwhatyourkidneysordered.
Aplant-baseddietdoesmorethanreduceyourriskofcomplications.Itmay
alsoreducetheamountofinsulinyouneed.Whenpeoplewithtype1diabetes
begin a low-fat, vegan diet, many report that their insulin requirements fall
dramatically. Although the reasons for this are not entirely clear, it is a very
welcomeresult.
Please read the next chapters very carefully. They will show you how to
begin.
Nosmoking. If you smoke, now is the time to stop. If you have tried 50
times,itistimefortrynumber51.Youcanandwillsucceed.Askyourdoctorto
helpyou.
Regularexercise.Evenmodestexercise,suchasdailywalking,makesabig
difference. See your doctor, who will assess your heart, your joints, and your
overallhealthtomakesureyouarereadyforexercise.SeeChapter11forways

togetstarted.

Stress management. Stress affects your health directly, causing fight-or-

flight hormones to flood into your bloodstream. In turn, these hormones

typically raise your blood sugar. Stress also disrupts your eating routines and

interfereswithsleep.

Gettingahandleonstressdoesnotmeansteppingbackfromthechallenges

oflife.Itmeansfindingwaystoenjoylifefullywithoutlettingstressgetoutof

control.Therearemanyhealthywaystorelax,includingmeditation,yoga,and

evensimplebreathingexercises.

Asyousawinthepreviouschapter,Dr.DeanOrnishshowedthatthesefour

steps—ahealthyvegetariandiet,smokingcessation,regularexercise,andstress

management—can actually reverse heart disease, even without the use of

cholesterol-loweringmedications.Thatisatremendousbenefit.Yourdoctormay

addmedicationstoyourregimentoprotectyoufurther.

Theselifestylechangeswillnoteliminatetheneedtouseinsulinfortype1

diabetes.Buttheycanhelpyoustayhealthy,minimizingtheeffectsofdiabetes

onyourlife.

ANEWUNDERSTANDINGOFTHECAUSESOFTYPE1DIABETES

Let’s think for a moment beyond improving the health of people with type 1

diabetes.Whatifwecouldactuallypreventitinthefirstplace?Researchover

thepast3decadessuggeststhatwemayalreadyhavetheabilitytopreventmany

casesoftype1diabetes.

Ifyouthoughtthediseasewassimplygeneticandtherewasnowaytostop

it,readon.Studiesofidenticaltwinshavesetthatnotionaside.Identicaltwins,

of course, have exactlythe same genes, so they have thesame hair color, eye

color, and facial features. If a disease were simply genetic, then both twins

wouldhave it.Buttype 1diabetesdoes notworkthat way. AsImentioned in

Chapter1,ifonetwinhasdiabetes,theotherhaslessthana40percentchanceof

developingit.

So,althoughgenesplayarole,itisclearthattype1diabetesisnotsimplya

genetic disease. Something else triggers it—something in the child’s early

environment.

For many years, researchers have known thattype 1 diabetes occurs when

the immune system attacks and destroys the insulin-producing cells in the

pancreas. Your immune system, of course, is your defense against viruses,

bacteria, and cancer cells. It is not supposed to attack your own healthy body

tissues,butthatisexactlywhatoccursintype1diabetes.

To understand why this happens, let’s look at a few basics. The complex

defensenetworkofyourimmunesystemismadeupofspecializedwhiteblood

cells.Someofthesecellsengulfinvadinggermsanddigestthem.Othersmake

antibodies—molecules that attach to invading organisms like harpoons and

identifythemforotherimmunecellstoattack.Ifyouhavetype1diabetes,your

immune system has made a major error: It has attacked and destroyed your

insulin-producingcells,resultinginwhatscientistscallanautoimmunedisease.

But why does it occur? Back in 1992, a team of Canadian and Finnish

researchers reported an important discovery in the New England Journal of

Medicine. Examining blood samples from 142 children newly diagnosed with

type 1 diabetes, they found that each of the children had antibodies that were

primedtoattackcow’smilkproteins.Theseantibodieshadapparentlyarisenin

response to cow proteins in their infant formula, but the antibodies were also

capable of attacking the body’s insulin-producing cells.

 It turned out that a

portionofthecow’smilkproteinwasbiochemicallyanexactmatchforaportion

ofhumaninsulin-producingcells.Theantibodiesthatarosetodestroythecow’s

milk protein ended up attacking the children’s insulin-producing cells. The

pancreaticcellsweredestroyedby“friendlyfire.”

Thisstudyandotherssuggestedascenariothatcouldleadtotype1diabetes.

Ithaslongbeenknownthatwhenaveryyounginfantisfedcow’smilkformula,

someofthemilkproteinspassfromthedigestivetractintothebloodstream.

5,6

It

ispossiblethattheinfant’simmunesystemrecognizesthesebovineproteinsas

foreignandformsantibodiestoattackthemandthattheseantibodiesattacknot

onlythecowproteinsbutalsotheinsulin-producingcellsofthepancreas.This

destructiveprocessispresumablygradual;whennearlyalltheinsulin-producing

cellsaregone,type1diabetesresults.Theresearchersbelievedthatthemature

digestivetractsofadultswouldnotallowthesedairyproteinstopassthroughthe

intestinal wall and into the bloodstream, but in infants, the molecules passed

throughmoreeasily.

The study suggested that one way to prevent type 1 diabetes, at least for

manychildren,mightbetoavoidexposuretocow’smilkearlyinlife.Needless

tosay,inthe early1990s,neitherparents norpediatricianshadany ideaabout

this.Cow’smilkformulaswereroutinelyfedtoinfants,andtheystillare.When

childrenarenotbreastfed,somesortofformulahastobeused.Andwhilesome

children are given soy formulas that would presumably pose no diabetes risk,

manyaregivencow’smilkvarieties.

In 1992, when the New England Journal of Medicine report emerged, the

well-known babydoctor Benjamin Spock, MD,andI held a pressconference.

We were joined by Frank Oski, MD, director of pediatrics at Johns Hopkins

University,andothernutritionexperts.Werecommendedthatparentsbegiven

informationaboutthepotentialrisksofearlyexposuretocow’smilk.Afterall,

parentsarepushedveryhardtogivecow’smilktotheirchildren,buttheyrarely

hearofpotentialrisksitmightpose.Wecalledforanendtorecommendations

thatpushmilkconsumptiononchildrenandsaidthatparentsshouldhavegood

informationinordertodecidewhattofeedtheirchildren.

The event proved controversial. Most major newspapers and broadcast

channelscoveredthestory.TheAmericanMedicalAssociation(AMA)sharply

criticized Dr. Spock and me for casting doubt on the healthfulness of dairy

products. Research teams trying to replicate these findings got mixed results,

with some coming up empty-handed. Still other researchers pointed out that

findingtheantibodiesrequiredspecialtechniques,withoutwhichtheantibodies

would remain elusive.

 Eventually, the American Academy of Pediatrics

convened a work group to look into the matter. Two years later, in 1994, the

group issued a report. Based on more than 90 studies, the group agreed that

indeed,theriskofdiabetescanverylikelybereducedifinfantsarenotexposed

to cow’s milk proteins early in life.

 Eventually, the AMA withdrew its

objections.

WhileDr.SpockandIfelttherewasalreadysubstantialevidenceandgood

reason to issue cautions about exposure to dairy products early in life, the

controversydidnotendthere.Therewasonlyonewaytoknowwhetherdairy

proteinscouldactuallyincitetheseriesofeventsleadingtotype1diabetes:The

theoryhadtobeputtothetest.Aeuropeanteambeganthatprocess.

TESTINGTHEDAIRY-DIABETESTHEORY

In a pilot study, researchers in Finland, Sweden, and Estonia identified 242

newbornsatriskfordevelopingtype1diabetes—eachhadafirst-degreerelative

withthecondition.Theresearchersthenencouragedtheirmotherstobreastfeed.

Whenmotherswerereadytoweantheirinfants,theresearchersaskedhalftouse

aspeciallymodifiedbabyformulainwhichdairyproteinswerebrokenupinto

individual amino acids—protein building blocks that are too small to elicit an

immunereaction.Theotherfamilieswere allowedtouse aregular cow’s milk

formula.The research aimedto see whetheravoiding exposureto intact cow’s

milkproteinscouldreducethelikelihoodofdevelopingdiabetes.

Astheyearswentby,theresearchersfoundthatthechildrenwhowerefed

thespecialformulaweremuchlesslikelytodevelopthedangerousantibodies.

Infact,theriskofdevelopingantibodiestotheirinsulin-producingcellswascut

by62percent.

Thestudywassmall,onlyapilottrial,butitdidfollowmostofthechildren

through their first 6 to 8 years of life. During those years, several children

developeddiabetes.Ofthosereceivingunmodifiedformula,eightdevelopedthe

disease,andinthemodified-formulagroup,fivedevelopedit.Asitturnedout,

two of those five had dropped out of the study right at the start and never

actually receivedthe modified formula. Thatmeant that only threechildren in

the modified-formula group developed diabetes, compared to eight in the

regular-formulagroup.Thestudysuggestedthatthecow’smilktheorymaywell

bepartofthepuzzle,butitwastoosmalltobedefinitive,andtheresearchteam

beganamuchlargertestin2002involvingfamiliesin15countries.

There were some limitations to this pilot study. First, it restricted dairy

consumptiononlyduringthefirstseveralmonthsoflife.Itisnotclearwhether

laterexposure,say,at8or9monthsofage,mightputsomechildrenatriskas

well.After all,ithas longbeen knownthatvery large dairyprotein molecules

cansometimespassfromthedigestivetractintothebloodstream,eveninadults.

Thestudydidnotaddresswhetherexposuretodairyproteinscouldtriggertype

1diabetesinchildrenwhoarebeyondearlyinfancy.

Second,thestudydidnotaskbreastfeedingmotherstoavoidcow’smilkin

their own diets. For decades, we have known that some cow’s milk proteins

ingested by a nursing mother end up in her breast milk. They come from her

digestive tract, are absorbed into her bloodstream, and find their way into the

breast milk, sometimes making babies colicky.

 Thus, in order to avoid

exposingbabiestodairyproteins,itisimportanttoeliminatethemnotonlyfrom

infants’dietsbutalsofromthedietsoftheirbreastfeedingmothers.

Onelastcautionaboutthisstudy:Itdidnotactuallyexcludedairyproducts

fromthechildren’sdiets.Rather,itusedamilkproducttreatedtobreakupthe

dairy proteins. If anything in milk other than these proteins contributes to the

problem, this study would not have been able to detect it. Even so, it was an

importantstepincomingtounderstandhowpartsofaninfant’sdietmayleadto

diabetes.

Thestudyilluminatedothercontributorstodiabetes,too.Priorevidencehad

suggested that viral infections may play a role, and indeed, viruses appear to

have done so for some infants in the milk study. Specifically, viruses seem to

stimulate immune cells, perhaps making them more active against cow’s milk

proteinsthantheywouldnormallybe.Or,cow’smilkproteinsmayinfluencethe

courseofviralinfectionsinsomeway.

Theideaisthattheinterplaybetween

cow’smilkformulaandvirusesmayputbabiesatincreasedrisk.

Nooneknowswhattheresearchonmilkandtype1diabeteswillultimately

show.Ifthetheoryturnsouttobecorrect,itsuggeststhatavoidingcow’smilk

products,atleastduringthefirstseveralmonthsoflife,couldgreatlyreducethe

likelihoodofdevelopingthisdisease.

Needlesstosay,breastfeedinginsteadoffeedingformulaposesnorisksfor

children.Quitetheopposite:Breastfedbabiesgainmanyadvantages,including

betteroverallhealthandevenafewextraIQpoints,comparedtotheirformula-

fed counterparts. And the most healthful breastfeeding is done when mothers

followadietfreeoffoodsthatcanharmtheirbabies.

Otherriskfactorsfordiabetesmayyetemergeinresearchstudies.Andfor

children who are already in the midst of an antibody attack, researchers are

studying means of intervening to try to stop the destruction of their insulin-

producingcells.

STAYINGHEALTHY

If we are able to prevent diabetes, we will have a very powerful tool at our

disposal.Forpeoplewhoalreadyhavetype1diabetes,thereareeffectivesteps

theycantaketohelpthemstayhealthy.Keepingbloodglucoseundercontrolis

essential,andstabilizingcholesterollevelsandbloodpressureprotectstheheart

andbloodvessels.Thesamesortofdietthatisdescribedinthisbookfortype2

diabetes is likely to be enormously beneficial for people with type 1 as well,

helpingthemtopreventcomplicationsandreducetheirinsulindoses.

Itisagoodideatoeliminatecholesterolfromyourdietcompletely.Thereisno“good”cholesterolin

foods.Rather,cholesterolinfoodsalwaystendstoincreaseyourbloodcholesterollevel.Thisisincontrast

tocholesterolthatismeasuredbybloodtests,whichdoctorsseparateinto“good”(HDL)cholesteroland

“bad”(LDL)cholesterol,amongotherforms.HDLcholesterolis“good”becauseitisleavingthebody.

PART2

TheProgram

CHAPTER4

APowerfulNewMenu

Wearesettingoursightsonadramaticallybetterresultthanpreviousdietscould

deliver—a result that’s possible through a new approach to eating that I will

explaininthischapter.Ifyouhavetype2diabetes,youdonotwanttocaterto

insulin resistance; you want to counteract it. If you have type 1 diabetes, you

want to get your blood sugar under good control, minimize your medications,

and stay in good health. This chapter will show you the principles of

revolutionizingyourmenu.Then,inthefollowingchapters,Iwillshowyouhow

toputthemtoworkasyouplanyourmeals.

Fortype2diabetes,ourgoalisto“cleanthegumoutofthelocks.”Asyou

recall, the fundamental problem in type 2 diabetes appears to be the

accumulationoftinyamountsoffatinsidemusclecells.Theymakeithardfor

insulinto do itsjob by blockingwhat iscalled insulin signaling.That is,they

interfere with the process by which insulin opens the cell membrane to allow

glucosetoenter.Youneedtoselectfoodsthatreversethisprocess.

Adietrevampcanalsohelpprotectyourbodyfromthediseaseprocess.That

iscrucialforbothtype1andtype2diabetes.

Asyouwillsee,thesedietchangesarefar-reachingandpowerful.Youmay

also find, as many of our study participants did, that learning the plan’s

guidelines is a simple process. There are no limits on portions, calories, or

carbohydrates.Youwillfocusonwhatyoueat,sohowmuchyoueatgenerally

takescareofitself.Butwearegettingaheadofourselves.

Let’sfirstlookatthemenuchangesthatmakethedietsoeffective.Then,in

the following chapter, I will walk you through various ways to adopt them to

makethisdietdoableforyou.

Toreversethecourseofdiabetes,“cleanthegumoutofthelocks,”andallow

theheartandbloodvesselsthebestchanceofreversinganyexistingblockages,

therearethreeguidelines.

1. Setasideanimalproducts.

2. Keepvegetableoilstoaminimum.

3. FavorfoodswithalowGlycemicIndex.

Now, there is no need to panic. I know this sounds like a tall order. I am

goingtowalkyouthrougheachsteptoshowyouthewhysandhows.Soon,it

willbesecondnature.Fornow,Ijustwantyoutounderstandtheprinciples.

1.SETASIDEANIMALPRODUCTS

Therearetwopossiblesourcesoffatinthediet:animalproductsandvegetable

oils.Thisguidelinetacklesthefirstofthese.

Needlesstosay,ifyouarenoteatingbeef,youwillnotgetanybeeffat.If

you are not eating chicken, you will not get any chicken fat. Following this

guideline means purging the animal fat from your diet. The program you are

abouttostartomitsmeat,dairyproducts,andeggs.

AsyousawinChapter2,researcherswhomeasuredthefatinsidethemuscle

cellsofpeopleonhigh-fatdietsshowedthatthefatyoueatcanrapidlyincrease

theamountoffatinyourcells.Exactlytheoppositeappearstohappeninpeople

whoavoidanimalproducts.Asyourecall,peoplefollowingavegandiethad31

percentlessintracellularfatcomparedwithpeopleonaregulardiet.

Thatmeans

improved insulin sensitivity. That is a great start, and the next guidelines are

designedtocarryyoufurther.

You will get another benefit. When you set aside animal products, you do

more than free yourself from animal fat; since animal products are the only

sourceofcholesterolinthediet,leavingthemoffyourplatealsoeliminatesall

thecholesterolfromyourdiet.Asyourcellsreclaimtheirhealth,therestofyour

bodydoes,too.

Insteadofeggsandbaconforbreakfast,youmighthaveabigbowlofold-

fashionedoatmealwithcinnamonorblueberries,halfacantaloupe,andsomerye

toast.Perhapsyoumightaddsomeveggiesausageorveggiebacon.

Forlunch,insteadof,say,meatchili,youmighthaveveggiechiliorhearty

lentilsoup.Ifyougenerallygoforaburger,youmightchooseaveggieburger.If

youhavedinneratan Italianrestaurant,you mighthave spaghettiwithtomato

sauce, wild mushrooms, artichoke hearts, and fresh basil. At a Mexican

restaurant, you would skip the meat taco in favor of a bean burrito (hold the

cheese)orveggiefajitas.AtaChineserestaurant,youcouldhaveyourpickof

themanyvegetabledishesonabedofrice.

Atthispoint,youmaybethinking,“Spaghetti?Rice?AmIallowedtohave

these carbohydrate-rich foods?” The answer is yes. Now, I know that people

withdiabeteshaveheardoverandoverthattheymustlimitrice,pasta,andother

starchyfoods.Butkeepinmindthatdiabetes—andoverweight—hasbeenrare

in countries that have made these foods their staples. The plan does have

guidelinesaboutcarbohydrates,buttheyrelatemainlytowhichonesarethebest

choices,nothowmuchyouputonyourplate.Inourstudies,wehavefoundthat

peoplewhoincludeplentyofhealthycarbohydratesintheirdietsdobetter,not

worse.

“Icanunderstandomittingbeef,”youmaysay,“butwhyeliminatechicken

andfish?”Well,thenutritionalmakeupofthesefoodsmaysurpriseyou.They

have significant amounts of fat and cholesterol, and they lack the fiber and

healthycarbohydrateyouneed.

Chicken,ofcourse,iswherechickenfatcomesfrom.Evenifyoustripaway

theskinandeatonlywhitemeat,about23percentofthecaloriescomefromfat.

Much of that fat is the “bad” form—saturated fat, the kind that pushes your

cholesterolupwardandworsensinsulinresistance.

Fish vary. Some types are lower in fat than chicken, while others, suchas

salmon,arequitehigh.Butallfishhavefat,andmuchofit—between15and30

percent—is saturated fat. Allfishhave cholesterol, too. Some, such as shrimp

andlobster,aremuchhigherincholesterol,ounceforounce,thansteak.

Ofcourse,somepeopleeatfishpreciselybecauseithasfatinit.Thatis,a

portion of the fat in fish is in the omega-3 form. Omega-3 fats are reputed to

blocktheformationofbloodclotsthatcouldleadtoheartattacks.

Scientific evidence has not been supportive. In large, carefully conducted

researchstudies,fishoilshavenotbeenshowntoprotecttheheart.Theydonot

reducethelikelihoodofaheartattackorstrokeorreducetheriskofdying.They

do not helphealthypeople who are trying to averttheirfirst heart attack, and

theydonotworkforpeoplewhohavealreadyhadaheartattackandaretrying

toavoidanotherone.

2,3

Could the supposed benefits of omega-3s be just a fish story? Well, it is

importanttorememberthatfishfatsaremixtures,justasallfatsare.Fishoilsdo

indeedcontainsomeomega-3fat,buttheyalsocontainplentyofsaturatedfat.

Asnotedabove,from15to30percentofthefatinfishisplainoldsaturatedfat.

That’slessthaninbeef(about50percent)orchicken(about30percent),butitis

considerablymorethanyouneed.Thereisnospecificneedforsaturatedfatin

yourdietatall.

The load of fat in fish might explain the disconcerting fact that fish

consumption is linked to a higher risk of developing diabetes. In 2009, the

American Diabetes Association reported in its journal, Diabetes Care, that

peoplewhoregularlyatefish,butnoothermeats,hada4.8percentprevalence

ofdiabetes,comparedto3.2percentforlactoovo-vegetariansand2.9percentfor

vegans.

 In other words, having fish in your diet does not help; it actually

increasesdiabetesrisk.

Similarly,Harvardresearchersfoundthatpeoplewhoatethemostfishhada

24 percent higher risk of developing diabetes, compared with those who

generallyavoidedfish.

Finally,ifyouarelookingtoloseweight,itisimportanttonotethat“good

fats” packin just asmany calories as“bad fats.” Thatis to say, omega-3s are

everybitasfatteningasanyotherfatoroil.Allfatsandoilshave9caloriesin

everygram,comparedwithonly4caloriespergramofcarbohydrate.

In practice, chicken-and-fish diets are routinely disappointing. We have

carefully tested these diets and found that, even when they are followed very

closely,theirabilitytoreduceLDL(“bad”)cholesterolisonlyabouthalfthatof

a plant-based (vegan) diet, and their ability to control blood sugar or blood

pressureortohelpyouloseweightislimited,too.

Muchmoreeffectivearedietsthateliminateanimalproductsaltogether.Our

studiesandthoseofotherresearchershaveshownthatplant-baseddietscutLDL

cholesterolfarmoreeffectivelythananyotherdietapproach.

Now,youwillnoticethatwhenyouavoidanimalproducts,yourdietisnot

justfreeofanimalfat;itisalsofreeofanimalprotein.Thatisimportantbecause

animalproteincanharmthekidneys,andprotectingthemisakeygoal.Protein

fromplantsourcesisthewaytogo.

If life without chicken or cheese sounds challenging, take heart from the

experiences of the folks who participated in our research. They found the

transitiontobesmooth.Theyfoundtastestheylikedbetterthantheiroldgo-to

foods. And within a few weeks, they were very much in charge—not only of

theirmenusbutalsooftheirhealth.Theyfoundthatexcessweightwasalready

starting to melt away, their blood sugar was coming under control, their

cholesterollevelswerefalling,andverysoon,manystartedtocutbackon—or

evendiscontinue—theirmedications.

WhataDifference:AnimalversusPlantFoods

FAT(%OFCALORIES) CHOLESTEROL(MG)

Salmon,Atlantic

Beef,bottomround,lean* 33 86

Chicken,whitemeat,skinless 23 85

Porkloin,lean 41 81

Trout,rainbow 35 69

Tuna,white 21 42

Apple 3 0

Beans,navy 4 0

Broccoli 11 0

Lentils 3 0

Orange 4 0

Rice,brown 7 0

*Meatservingsare3.5ounces(100grams).

SOURCE:USDA,AgriculturalResearchServiceNutrientDataLaboratory,

https://ndb.nal.usda.gov/ndb/search/list,accessedApril8,2017.

ReadyforaChange

Inoneofourresearchstudies,halfthevolunteerswereassignedtoalow-fatvegandiet,and

theotherhalfwereinstructedtofollowamoreconventionaldietfordiabetes.Sinceitwastobe

anunbiasedtest,thedietassignmentwasdonebyacomputer.Sotheprocesswasrandom,

andneither the volunteersnorwehadanyinfluenceoverwho got which diet. Nonetheless,I

wascurious about howthe volunteers felt aboutthe two diets,so I asked them. If therehad

beenanopportunitytochooseoneofthediets,whichonewouldtheyhavechosen?Iexpected

mostto say they wouldhave chosen the conventionaldiet—itis familiar to mostpeople who

havebeendiagnosedwithdiabetes,andIthoughtthevolunteersmightfeelabitoftrepidation

aboutgivingupmeatanddairyproducts.

Asitturnedout,theirpreferenceswerejusttheopposite.Thevolunteersactuallypreferred

thevegandietbyabouttwotoone.Thereason,Ilearned,wasthatmanyhadalreadybeenon

aconventionaldietandhadfounditdullandnotveryeffective.Manyofthemhadheardabout

theadvantagesofavegandiet.Othershadrelativeswhofollowedavegetarianorvegandiet,

andtheywantedtogiveitatry.

Bothgroupsembracedtheirassignments.Somedidwellontheconventionaldietandsome

didnot.Theresultswiththevegandiet,however,werepowerfulandconsistent.

HowNancyandVanceDidIt

HowdidNancyandVance,whomyoumetintheIntroduction,farewiththediet

changes?

ForNancy,thechangewasawelcomeone.Shewasfedupwiththelackof

results from the previous diet she had been given and thought a vegan diet

soundedlikeagoodapproach.Shewantedtoloseweight,andshewassickof

feelingsolowonenergy.This,shehoped,mightbeananswer.

Nancy grew up in Minnesota. Her mother was not an especially talented

cook,shesays,butherScandinavianfamilylovedfood.Hermotherandsisters

allstruggledwithweightproblems.

Likemostofourstudyvolunteers,Nancyhadalreadymadehealthychanges

toherdietovertheyears.Shehadstoppedeatingbeef,ateplentyofvegetables,

and hadgotten away fromfatty dressings, so makingthe shift wasreasonably

easy.

As she began the study, she started her day with oatmeal topped with

cinnamon and fat-free vanilla soy milk. At midmorning, she liked to have a

snack,usuallyfruitsuchasapples,bananas,raspberries,blueberries,grapes,or

oranges.

Forlunch,shehadaheartyvegansoupsuchasminestrone,vegetablesoup,

sweet potato soup, or chili, along with a salad made with fresh spinach;

tomatoes;red,yellow,andorangebellpeppers;kidneybeansandchickpeas;and

other ingredients. Her afternoon snack was often fruit, rye crackers, baked

tortillachipswithsalsa,orhummusandpitabread.

Afteralongdayatwork,Nancyhadnointerestinpreparingagourmetmeal,

so her dinners were quick and easy: a veggie burger with frozen mixed

vegetables, which she microwaved. Sometimes she had nothing more than a

bowlofbrancereal.Alate-nightfruitsnackroundedthingsout.

Wegavehergroupasupermarkettourandprovidedcookingdemonstrations

tointroduce everyone tohealthful productsthat mightbe newto them. Nancy

preferredtokeepitsimpleandstartedmakingalargepotofsouptoeatallweek.

“Iamnotacook,”shesaid.“AndIfinditveryeasytostayonthisprogram.”

Vanceusually startedhisday withoatmeal,eitherplain orwithapplesand

cinnamon. He also had toast and fresh fruit. Lunch or dinner was pasta or

burritos along with fresh vegetables and fruits. Sometimes his taste called for

salads,usuallydressedupwithbeans,bloodoranges,orotheradditions.

“I had to learn to read labels,” he said. “It is easy to underestimate the

amountoffatorsugarinacanoffood.Alabelmightshow6gramsoffat,and

you might think that means the whole can. But it actually means just one

serving.”

ForVance,thevegandietwasthewaytogo.“Idon’thavethepersonality

thatwouldletmehavejustasmallpieceofchickenorasmallpieceofbeef,”he

explained.“Ihavetocutitoutaltogether.Forme,thisisalifestylechange.”

THEPOWERPLATE

For starters, let me introduce you to the Power Plate, a simple meal-planning

guidethat mycolleagues andI developed. Theidea issimple: Buildyour diet

fromfourhealthystaples—wholegrains,legumes,vegetables,andfruits.

On yourplate,these simple ingredientsmight translate into aheartysweet

potatochowder,spinachlasagna,CubanblackbeansandSpanishrice,lentiland

carrotsoup,andendlessotherpossibilities.Butlet’sfirsttakealookatthestaple

foodsthemselves.Thesearetheingredientsthatbuildhealthfulmeals.

Thewholegraingroup.Thisgroupincludesbrownrice,oats,barley,corn,

andalltheproductsthataremadefromwholegrains:breads,cereals,pasta,and

many others. In countries where grains are staples, diabetes is much less

common than it is in North America and europe. This should be no surprise:

Whole grains are filling but have very little fat and no cholesterol. When

selectinggrains,lettheGlycemicIndexguideyoutothebestchoices.

Thelegumegroup.This categoryincludes beans, peas,and lentils.It also

includestheendlessarrayofsoyproducts,fromveggieburgerstomeatlesshot

dogs,tofu,tempeh,miso,andeveryconceivablekindofdelislice.Legumesare

hearty,high-proteinfoodswitharemarkablylowGI.Theyarerichincalcium,

iron,andcholesterol-loweringsolublefiber.Whetheryoufavorachickpeasalad,

blackbeanchili,orasoy-basedveggieburgerorothermeatsubstitute,legumes

arehandyandhealthy.

The one thing the bean group lacks is good public relations. Its health

benefits have gone largely unnoticed. Nutrition scientists, however, know that

puttingthesehealthypowerhousesfrontandcenteronyourmenuisagreatway

todrivedownyourweight,bloodsugar,andcholesterol.TheUSgovernment’s

National Nutrition and Health Examination Survey showed that people who

includedbeansintheirregularmenuweighed,onaverage,6.5poundslessthan

peoplewhogenerallyneglectedthishealthyfoodgroup.

Thetrendshowedup

inteenagers,too.Teenagebeanloversweighed7poundslessandhadwaistlines

thatwerenearlyaninchslimmercomparedwiththeirbean-avoidingpeers.

ResearchersattheUniversityofTorontoconfirmedthatpeoplewhoinclude

a serving of beans, chickpeas, lentils,or peas in their daily routine are indeed

thinnerandhavelowerlevelsofLDL(“bad”)cholesterol.

9,10

If you are new to bean dishes, go easy at first, keep portions modest, and

cook them thoroughly. They are likely to cause some gassiness until your

digestivetractadapts.

The vegetable group. Each member of the vegetable group is robustly

healthful. The green vegetables—asparagus, broccoli, spinach, kale, Swiss

chard,andmanyothers—arepackedwithironand,exceptforspinach,highin

absorbable calcium. Orange vegetables—carrots, yams, and butternut squash,

amongothers—areloadedwithbeta-carotene,acancerfighter.Begenerouswith

them.

Instead of the neglected little pile of overcooked vegetables some people

park on their plates, have two or even three different vegetables with your

dinner.One of myfavorite combinationsis “orangeplus green,” asin mashed

butternutsquashandbroccoli.SometimesIcookthemupfresh,andothertimes,

I simply use frozen. The colors contrast, as does the sweetness of the squash

withtheheartierflavorofbroccoli.Youdonothavetobeagourmetchef.Even

the most hurried person has time to open a package of frozen vegetables and

steamormicrowavethem.

Thesefoodsareloadedwithvitaminsandminerals,areverylowinfat,and

likeallplantfoods,havenocholesterolatall.

VirtuallyallhavehealthylowGIs.Themainexceptionisbakingpotatoes,so

favorsweetpotatoesinstead.

The fruit group. Fruits are loaded with vitamins and, of course, have

essentiallynofatorcholesterol.Manypeoplewithdiabetesimaginethatbecause

fruitsaresweet,theywillraisebloodsugar.Thefactis,though,thatnearlyall

fruits—apples, bananas, blueberries, cherries, clementines, oranges, peaches,

pears,andmostothers—havelowGIs.

For a simple and beautiful dessert, combine blueberries with chopped

mango,papaya,orbanana.You’llthinkofmanyothergreatcombinations.

Howmanyservingsshouldyou havefrom eachgroup? Youcan varyyour

serving sizes as much as you like. If you prefer Mediterranean cuisine, your

platemayberichinvegetablesandpasta.IfAsianfoodisyourthing,yourplate

mayholdgenerousportionsofriceorothergrains.IfyouloveLatinAmerican

foods,youmightgoforbeandishes.IfyoucomefromatypicalNorthAmerican

background,youwillprobablywantavarietyofallfour.Inthenextchapter,I

willshowyousomeeasy,deliciouswaystogetstarted.

It goes without saying that the recommended foods do not include meat,

dairyproducts,eggs,orgreasyfriedfoods.

Grapefruitinteractswithmedications

Surprisingasitsounds,ifyouareoncertainmedications,youmayneedtoavoidgrapefruit.

A serving of grapefruit or a glass of grapefruit juice can measurably increase the blood

concentrationsof drugs you may be taking, to the point of toxicity. Here’show it works: Let’s

say you were to swallow a cholesterol-lowering drug, like atorvastatin (Lipitor). Normally,

enzymesinyourintestinaltractandliverwillinactivatesomeofit,reducingtheamountthatis

activelycirculatinginyourblood.Thisisentirelynormal,andyourdosewasdeterminedwith

thatinmind.

Butgrapefruitknocksoutthesedrug-limitingenzymes.Asaresult,youendupwithmoreof

theactivedruginyourbloodstream.Abouthalfofalloralmedicationsaremetabolizedbythese

enzymes,andevenoneservingofgrapefruithasaneffectthatlastsallday.

Forcholesterol-loweringdrugs,thisisanissueforatorvastatin(Lipitor),simvastatin(Zocor),

and lovastatin (Mevacor), but not for pravastatin (Pravachol), rosuvastatin (Crestor), or

fluvastatin(Lescol),becausetheyaremetabolizeddifferently.

Grapefruitdoesthesamefordozensofotherdrugs.Soifyouhaveatasteforgrapefruit,

check with your doctor about how it might interact with any medications you are taking. The

sameeffectcomesfromlimes,Sevilleoranges(usedtomakemarmalade),andpomelos,but

notfromtypicalnavelorValenciaoranges.Theproblemoccursonlywithoralmedications,not

injectables.

OtherPermittedFoods

• Fat-freesaladdressingsandotherfat-freecondiments

• Coffee(withfat-freenondairycreamer,ifdesired)

• Occasionally,alcoholicbeverages

• Rarely, sugar, nuts,seeds, dark chocolate(madewithout milk),full-fat soy

productssuchastofu,tempeh,soycheese,etc.

FoodstoAvoid

• Meats,poultry,fish,eggs(whitesandyolks),andalldairyproducts(regular

andfat-free),includingmilk,yogurt,cheese,icecream,cream,sourcream,

butter,etc.

• Added oils, such as margarine, salad dressings, mayonnaise, cooking oils,

etc.

• Friedfoods,suchaspotatochips,frenchfries,onionrings,doughnuts,etc.

• Avocados,olives,andpeanutbutter

• FoodswithhighGIs,suchaswhitebreadorwhitepotatoes

VitaminB

andVitaminD

Althoughfoodswillgiveyoumostofthenutritionyouneed,twosupplements

areimportant:vitaminB

and vitaminD.VitaminB

is essentialfor healthy

nervesand healthyblood,and vitaminDis importantforyour bonesand may

reduce cancer risk. All typical multivitamins contain both and are very

convenient.Butbecausemultivitaminsalsohaveingredientsyoumaynotwant

(e.g.,iron andcopper),you caninsteadjustpickup thesetwovitamins atany

drugstoreorhealthfoodstore.You’llfindmoredetailsinChapter10.

SoupNirvana

Walter arrived at one of our research meetings to announce that he had found the perfect

lunch.HislocalsupermarketstocksalineofsoupsfromtheTabatchnickcompanythathappen

to come in several low-fat vegan varieties, such as black bean soup, split pea soup, and

vegetarianchili. Withsimple,naturalingredients, a servinghasabout200 calories andjusta

gramortwooffat.Theyareavailableinbothregularandlow-sodiumversions.Sincetheyare

frozen,theykeepmoreorlessindefinitelyandcanbemicrowavedtomakeamealinminutes.

There are also many other great brands, including Dr. McDougall’s, Health Valley, and

Amy’s,thatareeasy,quick,andhealthful.

HealthierSubstitutesforDairyProducts

Itmaysurpriseyoutolearnthatsomeofthebiggestsourcesoffatarelurkingin

the dairy section. Milk, cheese, and ice cream once enjoyed a healthful

reputationthatfewpeoplequestioned,butthathaschanged.Ithasbecomeclear

thatthesefoodsareactuallythelargestsourceofsaturated(“bad”)fatinthediet,

and also contribute cholesterol, animal protein, and, in the case of fat-free

varieties,abigloadoflactosesugar.

Here’sthelowdownondairy,followedbythegoodnewsabouthoweasyit

istoreplaceit.

Dairyfat. Cow’s milk derives, believe it or not, 49 percent of its calories

fromfat.Thatisalotbyanystandard.Youmayimaginethat2percentmilkis

muchlowerinfat.Notso.That2percentfigurereferstofatcontentbyweight,

whichisdeceptivebecauseitisthrownoffbymilk’swatercontent.Whenyou

drinkaglassofmilk,yourbodyabsorbsthatwater.Whatmattersforyourhealth

is how much fat you are left with. Nutritionists look for the percentage of

caloriesthatcomefromfatbecausethatfigureisunaffectedbywatercontent.It

turnsoutthatfor2percentmilk,about35percentofcaloriescomefromnothing

butfat.

What is particularly worrisome about milk, though, is the type of fat it

contains. Most of it is saturated fat, the very kind that is linked to insulin

resistanceand raisescholesterollevels.Dairy productsareactually theleading

sourceofsaturatedfatinthediet.

Typical yogurt, ice cream, and sour cream products are high in fat, too.

Cheeseisloadedwithit.Manybrandsderiveabout70percentoftheircalories

fromfat.

Dairysugar.Fat-freedairyproductshavehadtheirfatremoved,butwhat’s

still there may surprise you. When the fat is skimmed away, the predominant

nutrientinmilkisactuallysugar—lactose,thedairysugar.

The lactose molecule is a combination of two smaller sugars, glucose and

galactose.Approximately55percentofthecaloriesinfat-freemilkcomefrom

lactose.Peoplewhoquiterightlyavoidsodasandothersugarydrinksbecauseof

theirsugarcontentwillwanttobeawarethatmilkproductsareamajorsource

ofsugar,too.

Lactose,ofcourse,isthesugarthatcausesdigestiveupsetformanypeople.

Lactose intolerance is a normal condition that occurs when the enzymes that

allow babies to digest mother’s milk naturally start to dissipate. When these

enzymesaregone,lactosepassesthroughtheintestinaltractundigested.Inthe

lower intestinal tract, bacteria start to ferment the sugar, causing gas, cramps,

anddiarrhea.Lactoseintolerancewasoncethoughttobeanabnormalitybutis

now known to be the biological norm. The symptoms come on gradually,

sometime after early childhood, and they are simply a sign that you have
successfullypassedtheageofweaning.
Dairyproteins.Theseproteinshavecomeunderscrutinyfortheirpotential
contributiontotype1diabetes,asdescribedinChapter3,buttheyareimplicated
inmanyotherhealthconcernsaswell.Animalproteinsappeartoacceleratethe
gradual loss of kidney function that can occur in diabetes.
12
 Plant sources of
protein—beans, grains, vegetables, and soy products, for example—do not
appeartocausethisproblem.
People who have migraines often report improvement when they avoid
certainfoods,andmilkandotherdairyproductsareoftenatthetopofthelist.
Thesamehasbeenreportedforsomecasesofrheumatoidarthritis.Theproblem,
itappears,isnotthefatorlactose,atleastnotfortheseconditions.Thetrigger
seemstobethedairyproteins.
Dairy products are linked to other health problems ranging from acne to
prostate and ovarian cancer. It is the latter issue—cancer—that has gotten the
attention of the medical community. Two large Harvard studies and several
studies from other countries have shown that milk-drinking men have a
significantly higher risk of prostate cancer compared with men who generally
avoiddairyproducts.
13–16
Intryingtoexplainthisassociation,researchershave
pointedfingersatmilk’shormonaleffects,aswellaspotentiallyharmfuleffects
ofitshighcalciumandphosphatecontent.
17
Forovariancancer,theevidenceis
mixed,withsomestudiesshowing higherrisk amongmilk drinkersand others
showingnoincreasedrisk.
18,19,20
milk’s selling point has been the calcium it provides. There are, however,
bettercalcium sourcesand moreeffectivewaysof maintainingstrong bones.I
willgointomoredetailaboutthislaterinthechapter.
Makingbetterchoices.Peoplewhoavoiddairyproductsfindnoshortageof
great substitutes. Health food stores and regular supermarkets stock soy milk,
rice milk, almond milk, and many others. They come in regular, calcium-
fortified, and low-fat varieties and in plain vanilla, chocolate, and strawberry
flavors.Youwillwanttochoosethoselowestinfatandsugar.Calcium-fortified
juices have arrived on the market, too. Of course, none of these is necessary.
Aftertheageofweaning,theonlybeveragethatisactuallybiologicallyrequired
iswater.Notsoda,notjuice,notmilk—justpurewater.
Therearemanydeliciousnondairy icecreamsubstitutesmadefrom soyor
ricemilk.Inmanycases,however,themainreasontheyaresodeliciousisthat
theycontainaddedsugar.Yourtastebudscanbeeasilyseducedbythesetreats,
butyourbodywouldbefarbetteroffwithabowlofstrawberries.

AlternativestoEggs

Therearejusttwoproblemswitheggs:theyolkandthewhite.Theyolkiswhere

cholesterollurks,witharound200milligramsinasingleegg.That’ssimilarto

an8-ouncesteak.

Theyolkalsoholdsthefat,about5gramsperegg.Eggwhitehasproblems

of its own, since it is essentially pure animal protein. As you know by now,

animal protein can present problems for your kidneys, and you are better off

withplantprotein.

Cantherereallybeallthatfat,cholesterol,andanimalproteininsideasingle

egg?Certainly.Keepinmindthatwhenanegghatches,ababychickemerges.

Thatchick’s body—legs, wings,skin, feathers,internal organs, and everything

else—was formed from what was inside the egg when it was laid. So it was

loaded with cholesterol and other things you do not want. Like all animal

products,eggshavenofiberatallandnocomplexcarbohydrate.

Thereareplentyofgreatwaystoreplaceeggs,whetheryouarehookedon

scrambled eggs for breakfast or baked goods that include eggs. Try these

substitutes.

• Ifarecipecallsforjust1or2eggs,leavethemout.Addacoupleofextra

tablespoonsofwaterformoisture.

• Eggreplacementpowdersareavailableinmanyhealthfoodstores.

• Use1heapingtablespoonsoyflourorcornstarchplus2tablespoonswaterto

replaceeachegginbakedproducts.

• Tryanegg-sizepieceofmashedtofuinplaceofeachegg.

• Halfamashedbananacanbeusedinmuffinandcookierecipes,althoughit

willprovideitsownflavor.

• Formeatlessloavesandveggieburgers,useanyofthefollowingtobindthe

ingredientstogether:tomatopaste,mashedpotato,moistenedbreadcrumbs,

orrolledoats.

• Forabreakfastdishtoreplacescrambledeggs,scrambledtofuhasbecome

popular.Tofuhasatextureverymuchlikeeggwhiteandtakesontheflavor

of whatever it is cooked with. Be wary of products promoted as no-

cholesterol egg replacements; many are simply egg whites with various

addedingredients.

2.KEEPVEGETABLEOILSTOAMINIMUM

Oilscreepineverywhere,itseems:cookingoils,saladoils,vegetableoilsused

in baking and in snack foods.Vegetable oils do enjoyabetter reputation than

animal fat, and indeed, they have less saturated fat—the kind that raises

cholesterollevels.Butwestillwanttokeepalloilstoaminimum.Hereiswhy.

First,aswesawabove,allfatsandoilsareloadedwithcalories.Theyhave9

caloriespergram,whichismorethantwicethecaloriecontentofcarbohydrate

or protein (4 calories per gram). Thus, when it comes to calorie content,

vegetable oils are as fattening as lard. All fats and oils are in fact equally

fattening.

Second,ifyourgoalistoregainasmuchinsulinsensitivityaspossible,you

will want to eliminate not only animal fats but also added vegetable oils.

Cleaning the animal fat out of your cellular “locks” does no good if you are

goingtoclogthemwithvegetablegrease.Herearethesourcesoftheseoils.

Friedfoods.Frenchfries,potatochips, onionrings, andotherfriedsnacks

are essentially sponges carrying grease from the deep fryer to your body fat

stores.

Addedoils.Typicalsaladdressingsandmargarineshavelotsoffat.

Oils used as ingredients. Many packaged foods and sauces include

significantamountsofoil.

Oils used in sautéing. Many recipes begin with the instruction to sauté

onions,garlic, orotheringredients inoil. Somerestaurantsuse oilalmostas a

staple.

Thereareeasywaystoavoidallthatgrease.

• Steerclearoffriedsnackssuchaspotatochipsandfrenchfries.

• Top salads with fat-free dressings, lemon juice, balsamic vinegar, or

seasonedricevinegar.

• Usenonstickpans.

• Steam-fry onions, garlic, or vegetables in water or another cooking liquid

insteadofsautéingthetraditionalway.

• Steamvegetables.

• Inplaceofpouredoils,considerusingcookingspray.Ifyouusejustaquick

spritz,theamountofaddedoilistrivial.

• Usefat-freenondairycoffeecreamer.

• Readpackagelabels.Lookforproductswithnomorethan3gramsoffatper

servingorwithapercentageofcaloriesfromfatofbelow10percent.

Whenitcomestoavoidinggreasyfoods,somepeopleareeagertomakean

exceptionfor olive oil.It seemsnaturaland evenchic. But thinkfor asecond

about how factories manage to fill a bottle with oil. They take an enormous

numberofolives,discardtheirfiberandpulp,andleaveyouwiththefat.

Gramforgram,oliveoilhasthesamenumberofcaloriesasbeeffat,chicken

fat,andotherfatsandoils—thatis,9caloriespergram.Nootherfoodismore

calorie dense. While olive oil contains a great deal of monounsaturated fat,

whichhaslittleornoeffectoncholesterol,italsocontainssaturatedfat(about

14percent),thekindthatincreasescholesterolandworsensinsulinresistance.It

doesnotmatterhowexpensivetheoilisorhow“extravirgin”itmaybe.Itstill

has more calories and saturated fat than your body is designed to process to

maintainoptimalhealth.

There are, of course, traces of natural vegetable oils in vegetables, fruits,

beans,andgrains,butyouneednotworryaboutthem.Yourbodydoesneeda

tinyamountoffat,andplantsprovideitnaturally.Werunintoproblemswhen

oils are concentrated, as they are in fried foods, oily sauces, and recipes with

addedoils.

A few plant foods, such as nuts, seeds, olives, avocados, and some soy

products, are naturally high in oil. If you are trying to lose weight or tackle

diabetes,youwillwanttoavoidthem.

WhataboutGoodFats?

Therearetwotypesoffatyourbodyactuallyneeds.Theirtechnicalnamesare

alpha-linolenic acidand linoleic acid. These terms are not important; you will

neverseethemonaningredientslist.Whatisimportanttoknowisthatyouneed

onlyatinyamountofthem.Thebody’sneedfortheseessentialfatsisnomore

than2to3percentofyourdailycalorieintake.

Wheredo youfind them?Beans,vegetables, andfruits arevery lowinfat

overall,butthetracestheydocontainarerelativelyrichin“good”fat—thatis,

alpha-linolenicacid.Thisisthebasicomega-3fatthatyourbodyusestoproduce

othergoodfats.Nuts,seeds,andsoyproductscontainlargeramounts.Linoleic

acidisfoundinmanyplantfoods,too.

Somepeopleboosttheomega-3fatsintheirdiets.Ifyouaredoingthis,be

careful:Allfats, goodandbad, areequallyfattening,and manycontainthings

yourbodydoesnotneed.Fishoil,forexample,containsplentyofsaturatedfat

alongwithitsomega-3s.

Thebestwaytogettherightkindandamountoffatinyourdietistoskip

animalproducts,friedfoods,andoilyfoodproductsandgetyournutritionfrom

vegetables,fruits,beans,andwholegrains.

Does it really matter whether or not we avoid animal products and added

oils?Absolutely.AtypicalNorthAmericanorEuropeandietmightprovide80to

100gramsoffatperday,orevenmore.Switchingfrombeeftochickenandfish,

keeping portions modest, and limiting added oils will trim this to about 60

grams.Butsettinganimalproductsasideandavoidingaddedoilscandropthis

number to close to 20 grams. In the process, your cholesterol intake, which

wouldbewellover200milligramsperdayonanunmodifieddiet,willdropto

zero.Everycellinyourbodywillthankyou.

3.FAVORFOODSWITHALOWGLYCEMICINDEX

You will find this third guideline very useful. The glycemic index (GI) is a

handytoolthatwasinventedbyDavidJenkins,MD,PhD,DSc,aphysicianand

researcher at the University of Toronto.

 It is simply a number that indicates

howrapidlyanygivenfoodreleasessugarintothebloodstream.Afoodwitha

highGIreleasessugarintothebloodquickly.

One example is white bread. If a molecule of carbohydrate in bread was

greatlymagnified,itwouldlooklikeastringofbeads.Eachbeadisamolecule

of sugar (glucose). In your digestive tract, these beads separate and pass into

yourbloodstream.

With white bread, this process is quick. The string of beads rapidly

disintegrates,andtheindividualglucosemoleculesraceintoyourbloodstream.

Ifyouweretocheckyourbloodsugaraftereatingthebread,youwouldseethe

result.WhitebreadhasahighGI,meaningithasapronouncedeffectonyour

bloodglucose.

Incontrast,pumpernickelbreadhasalowGI.

Its“beads”comeapartmore

slowly,passingintothebloodstreambitbybit.Ithasmuchlesseffectonyour

bloodsugar.

Inanutshell,high-GIfoodstendtohaveagreatereffectonyourbloodsugar,

andlow-GIfoodshavelesseffect.

IshouldmentionthatwhenresearchersmeasuretheGIofindividualfoods,

theytestvolunteerswhodonothavediabetes,soafoodthatdoesnotraisetheir

bloodsugarverymuchcouldraiseyourssomewhatmore.However,thepointof

theglycemicindexistoallowustoratefoods—tocompareoneagainstanother

—sowecanchoosethebestones.

IfyouweretodoanonlinesearchforinformationabouttheglycemicIndex,

you would soon discover a mind-numbing array of tables from a variety of

sources,noneofwhichagreewitheachother.ThatisbecausetheGIofanyfood

can vary depending on the brand, how it was prepared, and other factors. So,

let’skeepthingssimple.HereisallyouneedtoknowabouttheGI:

GlycemicIndexataGlance

• White and wheat breads are high GI. Rye and pumpernickel are better

choices.

• TablesugarishighGI.Fruitsarebetter.Theygiveyouasweettastewitha

suprisinglylowGI.

• WhitebakingpotatoesarehighGI.Sweetpotatoesarelower.

• MostcoldcerealsarehighGI(especiallyiftheyhaveatoyinsidethebox).

Oatmealandbrancerealsarebetter.

Andhereareafewmoretips,forextracredit:

• Beansandtheirrelatives(lentils,peas)arealwayslowGI.

• GreenleafyvegetablescanalsobeconsideredlowGI(althoughtheyhaveso

littlestarchthattheirGIstypicallyhavenotbeencalculated).

• Pastaisalow-GIfood.Becausepastaiscompacted(unlikebread),itdigests

slowlyandreleasesitsnaturalsugarsonlygradually.Moreonthisbelow.

• Barley,bulgur,andparboiled(converted)riceallhavealowGIvalue.

Now,ifyouhavetype2diabetes,anyfoodwithcarbohydrateinitwillpush

yourbloodsugaruptoadegree.Infact,ariseinbloodglucoseafteramealis

normal,andifyourcellsareinsulinresistant,ittakesabitmoretimeforglucose

inyourbloodstreamtopassintoyourcells.Thisdoesnotmean,however,that

youshouldavoidfoodsthatcontaincarbohydrate.Whatitmeansisthatyouwill

wanttotakestepstoreduceyourinsulinresistance,asoutlinedinthischapter.

Amongcarbohydrates,thebestarethosewithalowGI.

ThereasonImentionthisisthatsometimespeoplewithtype2diabetesshun

carbohydrates. They avoid rice, beans, pasta, and all the rest and load up on

chicken,fish,andeggsbecausethesefoodshavenocarbohydrate.Butoverthe

longrun,theyfindtheirbloodsugardoesnotimprove;theirlevelgetsworse,so

they need more and more medicine.It makes sense when you think about the

factthatthesefoodscontributealoadoffatandaggravatetheaccumulationof

fat in cells—more gum in the locks, so to speak. Greasy meals today mean

insulinresistancetomorrow.

ItmaysurpriseyoutolearnthatpastahasalowGI.Itdoes,particularlyifit

isservedaldente,thatis,notovercooked.Ofcourse,pastaismadefromwheat

flour, so you may think it would spike your blood sugar in the same way as

wheatbread.Butthatisnotthecase.

Pasta actually gives us a little lesson in why some foods have a high GI,

whiletheGIofothersislow.

Let’ssaywearemakingbreaddough.Weaddabitofyeasttotheflourto

makethebread rise.Theyeastcauses manytinyairpocketsto form,whichis

what makes bread different from, say, a shingle. Now, as you eat the baked

bread, your stomach acid and digestive enzymes enter those air pockets and

rapidly break the molecules of flour into individual sugar molecules that then

passfromyourdigestivetractintoyourbloodstream.Evenwholewheatbread,

with shreds of fiber remaining, is easy pickings for digestive enzymes—they

havenodifficultyenteringtheairpocketsanddigestingthestarchinthebread.

pastaisdifferent.Itisnotmadewithyeast,soithasnoairpockets.Ifbread

islikeapileoftinytwigs,readytoignitewithasinglespark,pastaislikeacord

oflogs—itismuchmorecompactedand“catchesfire”moreslowly.Evenifyou

chew pasta thoroughly, there is no way it can digest as rapidly as bread—and

that’swhyithasalowerGI.

Thetake-homelessonisthatprocessingfoods—pulverizinggrainsintoflour

or using yeast to make dough rise, for example—starts the digestive process

beforeyouevenputthefoodonyourplate.Anintactgrainisslowtocomeapart

and release glucose into your bloodstream, while a heavily processed grain is

likely to disintegrate quickly. Thus, old-fashioned oatmeal, which consists of

wholeoats,hasalowGI.Butquick-cookingoatmealismadebyslicingtheoat

grainsintofragments.Thatallowsittocookfasterandtodigestfaster—which

meansahigherGI.

IfyouwouldliketolookuptheGIofindividualfoods,youcantakealook

at a Web site established at the University of Sydney in Australia:

glycemicindex.com.Justtypeinthenameofthefood,andallthetestingresults

willappear.

“Doesitreallymatter?”youmaybeasking.“Canitreallymakeadifference

ifmyoatmealisold-fashionedinsteadofinstant,orifIbringbeans,greenleafy

vegetables, and barley soups into my life?” Jennie Brand-Miller, PhD, of the

UniversityofSydney,answeredthatquestionbyanalyzingthecombinedresults

of14studiesontheglycemicindexthatincludedatotalof356participants.She

found that choosing low-GI foods reduces hemoglobin A1C by 0.3 to 0.4

percentage point. In some studies, the difference was as much as 0.6 point.

Studiesshowedasimilarbenefitforbothtype1andtype2diabetes.

This advantage is over and above that of the other diet changes you are

making. As you will remember from Chapter 2, the combined diet changes

described inthis book—avoiding animal products,minimizing oils, and eating

low-GIfoods—addeduptoanA1Cdropof1.2percentagepoints,onaverage,in

ourresearch.Thataverageincludespeoplewhodidnothaveveryfartodropas

wellassomeparticipantswhostartedwithA1Csinthe9to10percentrangeand

dropped several percentage points. These results are stronger than any single

drugislikelytobring.Forsomepeople,thatisallittakestoreturntheirA1Cto

thenormalrange.

TWOIMPORTANTSUPPLEMENTS

Fruits, vegetables, beans, and grains provide the healthy nutrition you need.

Eating these foods, you are much better nourished than you would be on a

meaty,dairy-filleddiet,becausethesehealthy,plant-basedfoodsarerichinfiber,

vitamins,andotherplant-basednutrients,whilehelpingyouskipunhealthfulfats

andcholesterol.Evenso,therearetwosupplementsthatareimportantforyouto

knowabout.

VitaminB

.VitaminB

isessentialforhealthynervesandhealthyblood

cells. If your B

 level runs low, you could have nerve symptoms that are

permanent. But this vitamin is not made by animals or plants. Rather, it is

producedbybacteria.Howdoesthissubstancegetfrombacteriatothehuman

body? Some have suggested that before the advent of modern hygiene, there

weretracesofbacteriainthesoil,onvegetablesandfruits,onourfingers,orin

ourmouthsthatprovidedthetinytracesofvitaminB

thatweneed.Whether

thatwasevertrue,itiscertainlynotareliablesourcetoday.Bacteriainanimals’

intestinaltractsproducevitaminB

,andtracesofitendupinmeatandother

animal products. The problem with these sources is that along with it come

cholesterol,fat,andanimalproteins.B

isalsoaddedtosomefoods,asyouwill

sometimes see on the package labels of breakfast cereals, soymilk, nutritional

yeast,and otherproducts.The bestsourceis avitaminB

 supplement, which

youwillfindatanydrugstoreorhealthfoodstore,andyoushouldtakeitdaily.

Thedoseisnotespeciallyimportant,becauseallcommonbrandshavemorethan

therecommendeddailyallowance,andevenhighdosesofB

donotappearto

bedangerous.

Vitamin D. Technically, vitamin D is not a vitamin at all. It’s actually a

hormone produced by sunlight on your skin. Once activated in your liver and

kidneys,ithelpsyouabsorbcalciumandhelpsprotectyourcellsagainstcancer,

amongotherfunctions.

Ifyougetplentyofsun,youdonotneedanyvitaminDinyourdiet.Butif

you do not get regular sun exposure, a vitamin D supplement is important. A

reasonabledailydoseis2,000IU.

PUTTINGTHERIGHTFUELINYOURTANK

Nowwehavecoveredthebasics,thethreeguidelinesthatworktogethertohelp

you regaincontrol: avoidinganimal products,keepingoils toa minimum, and

favoringlow-GIfoods.

These guidelines work together. Meeting one of them is not enough. For

example, jelly beans can be vegan, and they are low in oil. Because they are

essentiallysolid sugar, though,they have ahigh GI andwill spike yourblood

glucose.

Similarly,asnackcakeloadedwithbuttercanhaveaverylowGIbecause

butter contains no carbohydrate and may even slow the absorption of glucose

youeat.Butthesnackcakeisnotvegan,norisitlowinfat.Itwillcontributeto

insulinresistance,andyouwanttosteerclearofit.ThelowGIisnotareasonto

eatitifitdoesnotmeetourothercriteria.

Thethreeguidelinestogetherareapowerfulcombination.Nancy’sA1Cwas

8.3percentatthebeginningofourstudy.Asshebeganthehealthydietchanges,

it rapidly slid under 7.0, even while she reduced her medications. For Vance,

initialA1Ctestingshowedavalueof9.5percent,butastheweekswentby,it

dropped and dropped and dropped. By the study’s conclusion, his A1C was a

healthy5.3percent.

Now,beforeweplanoutyourbreakfast,lunch,anddinner,letmeshowyou

howthesethreeprinciplestranslateintochangesinsideyourbody.Justasacar

performsdramaticallybetterwhenithasthefuelitwasdesignedfor,yourbody

performsfarbetterwhenyougiveitthefoodsitneeds.

Increasedinsulinsensitivity.Asyouknowbynow,evidenceshowsthata

dietchangecanhaveaquickanddecisiveinfluenceontheamountoffatinside

your cells. As the amount of fat drops, your cells become more and more

sensitive to insulin, allowing your blood sugar to come down. If your insulin

resistancewaspreviouslyworseningandyourmedicationdosesincreasing,the

processbeginstoreverse.

Thiscanhappenremarkablyquickly.Infact,itcanhappensoquicklythatit

isessential,ifyouareusinginsulinoranydrugthatincreasesinsulinsecretion

(forexample,glipizide,glimepiride,glyburide,nateglinide,orrepaglinide),that

you be in close touch with your doctor. As your cells regain their insulin

sensitivity,youwillbecomemoreandmorelikeahealthypersonwhoistaking

drugsheorshenolongerneeds.

Thecombinationof ahealthydietand thedrugsyouhave beentakingcan

drive your blood sugar down to healthful levels and then below them, to

hypoglycemia.Inotherwords,yourbloodsugarcanfalltoolow,whichcanbe

dangerous. Your doctor will lower your medication doses or even discontinue

yourmedicationsasnecessary,whichwillsolvetheproblem.Now,donotthrow

yourmedicinesawayonyourown.Yourdoctorwillguideyou.Anddonotbe

frightenedbythisreturntohealth.Itisawonderfulfeelingtodiscoverthatyour

insulinsensitivityisimprovingdaybyday.Whenyourdoctorsaysit’stimeto

cut back on medication or stop a drug altogether, it is as if time is moving

backward.

Chapter7 has importantdetails on how to prevent and treathypoglycemic

episodes.Pleasereaditcarefullybeforeyouchangeyourdiet.

Easyweightcontrol.Ifyouhavebeenhoping tolose weight,that process

hasjustbegun.Onaverage,thedietyouarebeginningcausesaweightlossof

about1poundperweek.Astimegoeson,itaddsuptoanimpressivechange.

“Howdoes thiswork?”you mayask. Howcanyou loseweightif youare

payingnoattentionatalltoportionsizes,calories,andcarbohydrates?Thereare

threemainreasons.

First,thefoodshaveverylittlefat,soyouareeliminatingthemainsourceof

unwantedcalories.

Second,thevegetables,fruits,beans,andwholegrainsyouarebringinginto

your diet give you a healthy dose of fiber, which is filling enough to turn off

yourappetiteabitsoonerthanwouldhappenwithoutthem.Onaverage,each14

grams of fiber cuts about 10 percent off your calorie intake. A person who

normallyeats2,000caloriesperdayandthenstartstoaddanextra14gramsof

fiberdailywilltendtofeelfullaftereating1,800calories.

Third, these foods cause a slight boost in your after-meal calorie burn.

Normally,youburncaloriesfasterafteramealduetotheprocessesofdigestion.

Ourstudieshaveshownthatalow-fatvegandietincreasesthisafter-mealburn,

givingyouanextraedge.

IwillgooverthisinmoredetailinChapter6.For

now,justenjoytheweightcontrolthatiskickinginonitsown.

Losingexcessweight feelsgreat,of course,butweight lossimprovesyour

insulinsensitivityinadditiontotheeffectsofthedietchangeitself.

Easy cholesterol control. If you have had a cholesterol problem, the

programyou are nowbeginning is farmore powerfulthantypical cholesterol-

lowering diets. This should be no surprise. Your new diet is not low in

cholesterol; it has no cholesterol at all. It also has no animal fat, which is

important because animal fat (like other sources of saturated fat) encourages

yourbodytomakecholesterol.Theyareallgonenow.Youhavereplacedthem

withcholesterol-lowering oats,soy,and other botanicalmagicians,as youwill

seeinmoredetailinChapter12.

Yourarteriesarestartingtobreatheasighofrelief.Thedamageofdiabetes

isdonetothearteries,forthemostpart,leadingtoproblemsinyourheart,eyes,

kidneys,andnerves.Butnow,youareinhibitingthatprocess,andbringingyour

cholesterolleveldown ispartofit. You arefollowingthe kindofdiet usedin

programstoreverseheartdisease.

Again, do not throw your medications away and cancel your doctor

appointments.Yourdoctorcansizeupyourhearthealthandtrackyourprogress.

Reversingsymptoms.AteamofCaliforniaresearchersusedalow-fatvegan

diet,combinedwithexercise,inagroupof21peoplewithtype2diabetes,allof

whomhadpainfulneuropathy—thenervesymptomsthatariseasthenervesare

damaged.Injust2weeks,17ofthe21reportedcompletecessationoftheirnerve

symptoms,andtheremaining4hadnoticeableimprovements.

Soourresearch

teamdidatestofalow-fat,vegandietalone—withoutexercise—andfoundthat,

indeed,itcanimprovenervefunctionandreduceneuropathysymptoms.

otherresearchershavefoundthatsomeofthechangesintheeye—exudates

in the retina—that sometimes occur in diabetes start to improve or even

disappearwhenpeoplemakeahealthydietchange.Thelossofproteinthrough

the kidneys can also diminish. You will find more details on all of these in

Chapter13.

FIRSTSTEPS

Oneofthethingswehavecarefullytestedwiththisprogramishowpeoplefeel

aboutit.Bottomline:Althoughyouwillbemakingmajorchangesinyourmenu

thataredesignedtobring youuncompromisedgoodhealth,this isperhaps the

easiestdietchangetostickwithoverthelongrun.Partly,thatisbecauseitisnot

a“diet.”Itisadifferentwayofregardingfood—amuchbetterwayofthinking

aboutandenjoyingit.Also,youwillnevergohungryandneverteaseyourself

withminusculeportionsoffoodsyoulove.

Letmeshowyouthestepsthatmakeitthatway.Forthemoment,youare

notactuallygoingtochangeanything.Ijustwanttowalkyouthroughthesteps

thatwillgetyoustarted.

Step1:CheckOutthePossibilities

Before you jump into a new way of eating, take a week and check out a few

recipesandnewfoodproducts.Lookthroughthenextchapterforideas.Youwill

findagreatmanypossibilitiestogetyoustarted.Ifyourarelycookandtendto

eatatrestaurants,thenextchapterwillhavemanytipsonthingsyoucanlook

for.

Your goal is to identify healthy breakfasts, lunches, and dinners that you

reallylike.Thatmeansmealsthatmeetallofourguidelines(noanimalproducts,

minimalvegetableoils,andlowGI)andappealtoyourtastes.

Remember that this new way of eating does not mean making a new dish

every night. William Castelli, MD, former director of the Framingham heart

Study, usedtosaythatmostofustend tostickto ourfavoritemeals.Wemay

havefourorfivedifferentdinnerswelike,andwepickfromthatrepertoirenight

afternight.Allyouneedtodoistofindhealthymealsthatsuityourtastes,and

youareset.Aweekismorethanenoughtimetodothat.

Step2:Pick3Weeks

Somepeopleliketoeasetheirwaygraduallyintoahealthierdietpattern.Ifyou

are among that group, go ahead and take your time getting to know healthier

foods.ButIadviseadifferentapproach.Marka3-weekperiodonyourcalendar

when you plan to embrace this program. Before you reach your start date,

identifymealsthatfitourcriteriaandappealtoyou.Whenthestartdayarrives,

commityourselfcompletelyfor21days.

AsItellourresearchparticipants,thisisnotthetimetostickyourtoeinthe

swimmingpool;it’stimetojumpin.Reallydoit.Makeitalllow-fatvegan,all

thetime.Therearetworeasonsforthis.

First, it gives you fast results. If you have a healthy meal on monday and

anotheronSaturday,yourbodywillnotnoticeanydifference.Butifyoudoitat

everymeal,gainscomequickly.Giveyourselfachancetoseehowitfeelstobe

onasperfectadietaspossible.

Thesecondreasonisthatadietchangereallyislikegettingintoaswimming

pool.Ifyoueaseyourwayintothewaterbitbybit,itisapainfulprocess.Butif

youplungein,verysoonyouseethatthewaterfeelsfine.Letmeexplain.

Didyoueverswitchfromwholemilktofat-freemilk?Ifyouarelikemost

people, that first glass of fat-free seemed watery and maybe even discolored.

After a couple of weeks, though, you became totally used to the lighter taste.

Beforelong,wholemilkseemedthickanddistasteful.

Now, I am not suggesting that fat-free milk is a health food. As you have

seen,there are goodreasons toavoid it.But when youlighten your diet,your

tastesrapidlychange.Verysoon,youcometopreferthenew,healthiertaste.

You will find that your taste buds have a memory of about 3 weeks, and

jumping into the diet change allows them to adjust quickly. Instead of pining

overtheunhealthyfoodsyouhaveleftbehind,youwillbesurprisedtofindthat

youmissthemverylittle.

Ifa100percentdietchangesoundslikeatallorder,letmemakeitabitmore

approachable.Youdonotneedtocommittoitforever;youjustneedtogiveita

try. At this point, there’s no need to swear off bacon double cheeseburgers,

pledgeyourloyaltytooatmeal,ormakeanyotherdauntingpromises.Justgiveit

3weeks.Duringthattime,reallydoit100percent,andyouwillgetagoodsense

ofwhatthedietwilldowhilestillkeepingallyouroptionsopen.

GETTOKNOWTRANSITIONFOODS

Modern technology has brought us plenty of modern annoyances (ringing cell

phones, crowded freeways,and junk e-mail), but once in a while,it’s actually

useful. The food industry has managed to mimic unhealthy foods with more

healthfulvarieties.

Thehotdog,longreviledbynutritionists,gainedameasureofrespectability

once food scientists figured out how to transform soybeans into a frankfurter.

Veggie hot dogs, veggie burgers, and veggie sausages debuted in health food

stores but are now sold everywhere. Even deli salami, turkey, chicken, and

bolognasliceshavesoyorwheatcounterpartsthatlookandtasteverymuchlike

therealthing,withzeroanimalfatandcholesterol.

Thesefoodsarehardlythepinnacleoffinedining,buttheyarepractical.If

youhavechildren,theyareanabsolutegift.Ifyousawwhatgoesintoarealhot

dog, it would become the last thing you would want to see heading for your

child’smouth.Butaveggieversionissomethingyoucanbringhomewithpride

—andyourkidswilllovethem.Theseproductshelpyouthroughthetransition

toabroaderrangeofhealthyfoods.

Soymilkhasarrivedbigtime.Once,buyingsoymilkmeantshoppingata

healthfoodstorethatwasdingy anddark. Thecashier waswearingatie-dyed

shirt,hisnamewasSunshine,andfolkmusicwasplayinginthebackground.

Well,thosedaysaregone.Healthfoodstoresarebigbusinessesthatknowa

thing or two about customer service. Regular supermarkets stock dozens of

flavors of soy milk, along with rice milk, almond milk, oat milk, and other

varieties,too,andpeoplefromallwalksoflifeenjoythem.

Asyoushopformeatanddairysubstitutes,takealookatthelabels.When

youchecktheingredientlists,youwillseethatsomeproductsarenotquiteas

vegan as you might like because they include egg whites or dairy proteins.

Choosetheveganversions,andlookforthosethatarelowestinfat.

COMPLETENUTRITION

When youfollow the nutritionguidelines inthis chapter, yourdiet is likelyto

improvedramatically.

Notonlywillyouskipalltheanimalfatandcholesterol,

youwillgetmuchmoreofthehealthynutrientsyourbodyneeds:solublefiberto

cutcholesterol,healthyvitaminstoreducecancerrisk,potassiumtolowerblood

pressure,andantioxidantstoknockoutfreeradicals,tonameafew.

Evenso,youaremakingabigchange,andyouarelikelytowonderwhether

you are missing out on anything. Let me offer a word of reassurance. If you

choose your meals from a variety of whole grains, legumes, vegetables, and

fruitsandtakemyadviceaboutvitaminB

andvitaminD,above,youwillhave

yourbasescovered.

here’swherethehealthynutrientsareonyourplate.

Protein.Yourbodyusesproteintobuildandrepairbodytissues.Proteinsare

made upofsmall molecules called aminoacids. All the proteinsin your skin,

muscles,bones,andinternalorgansarebuiltfromvariouscombinationsofabout

20differentaminoacids.

Ahealthydietofbeans,grains,vegetables,andfruitsprovidesalltheprotein

you need. In fact, you are betteroff getting protein fromplant sources. While

animalproteincanbehardonthedelicatetissuesofthekidneys,plantproteins

appeartobefreeofthisproblem.Theyarealsofreeoftherisksofcalciumloss

and kidney stones associated with animal protein.

 Animal protein tends to

cause calcium to pass through the kidneys and into the urine. In the process,

calciumisnotonlylost,butitendsupinyoururinarytract,whereitcancause

stones.

Inyearspast,somenutritionistsbelievedthatvegetariansneededtocarefully

combinevariousfoodsinordertogetadequateprotein.Theideawasthatfoods

fromplantsmightbemissingoneormoreaminoacids,soonlycombiningfoods

incertainwayscouldensurethatyougotthemall.Thisnotionwassetasidelong

ago.TheAcademyofNutritionandDietetics’officialpositionstatementsmake

itclearthatplant-baseddietsprovideplentyofproteinwithoutcombiningfoods

in any particular way.

 If, for any reason, you wish to increase your protein

intake, turn to the bean group. You will find extra amounts of protein in soy

products, such as tofu, tempeh, and soy milk, and in wheat derivatives (e.g.,

seitan)usedtomakemeatsubstitutes.

Calcium.Formanypeople,calciumandmilkarealmostsynonymous.They

thinkthatmilkwillbuildstrongbonesandprotectagainstfractureslaterinlife.

Researchhasshown,however,thatmilk’sbenefitsare,forthemostpart,amyth.

Studiesdo notshowmuch benefitfor thebonesfrom drinkingmilk. Howcan

thatbe?Well, onlyaboutone-thirdof milk’scalciumisabsorbed bythebody.

The other two-thirds simply passes out with the wastes. In addition, milk

containsanimalproteinandsodium,bothofwhichtendtoincreasecalciumloss

throughthekidneys.

Donotmisunderstandmehere—youneedsomecalciuminyourdiet,butit

shouldcomefromhealthfulsources, namelygreen leafyvegetablesandbeans.

While there is somewhat less calcium in broccoli than in milk, the absorption

fraction—thepercentagethatyourbodycanactuallyuse—ishigherforbroccoli

andnearlyallothergreensthanformilk.Thereisoneexception:Spinachishigh

incalcium,buttheabsorptionfractionisverylow.

Greens and beans will give you the calcium your body needs. If you are

looking for extra calcium for whatever reason, you can find plenty more in

fortifiedjuicesandsoymilks.

Tomaintaincalciumbalance,however,itisimportantnotonlytotakeinan

adequateamountbutalsotominimizelosses.Animalproteincausesyourbody

tolosecalciumthroughthekidneys,anditcanbemeasuredintheurine.Studies

of high-protein diets, such as the Atkins Diet, dramatically demonstrate the

losses: Suchdiets increased calciumloss by morethan 50 percent.

 It is also

important to limit sodium (salt) and get vitamin D from either sunlight or

supplements. Vegetables and fruits promote bone strength for reasons that are

notentirelyclear,andexercisegivesyourbonesareasontolive.Itisastrong

determiner of bone health. Finally, it is also important to avoid tobacco, since

smokingincreasesfracturerisk.

Iron. Iron is a double-edged sword. You need iron to build hemoglobin,

whichyour red bloodcells use tocarry oxygenfrom your lungsto your body

tissues.Buttoomuchironcanbetoxic.Itcanincreasetheriskofheartproblems

andmayevenworseninsulinresistance.

Iron encourages the production of unstable molecules called free radicals,

whichcandamageyourbody’sdelicatetissuesandarelinkedtoheartdisease,

cancer,andevencertainaspectsoftheagingprocess.

Themosthealthfulironsourcesarethesamefoodsthatbringyoucalcium:

beansandgreenleafyvegetables.Theyarerichinironbutcarryitinaspecial

formcallednon-hemeiron.Yourbodyeasilyabsorbsthisformwhenit’sinneed

ofmoreiron,buttheironpassesharmlesslyoutofthebodywhenyouhaveall

youneed.Incontrast,meatscontainhemeiron,whichislikeanuninvitedguest

atyourparty:Itbargesinwhetheryouneeditornot.Overthelongrun,meat

eaterstendtoaccumulatetoomuchiron.

Ifyouareanemic,donotrushoutandbuyironsupplements,orworse,add

lotsofmeattoyourdiet.Instead,workwithyourdoctortofindoutwhatkindof

anemiayouhaveandwhyitoccurred.Anemiacanbeasignofkidneydisease;it

can be caused by certain drugs; and it can be a sign of blood loss from your

digestive tract caused by gastrointestinal irritation or even colon cancer. It is

essentialthatyoubeevaluatedandtreatedappropriately.

If you do need extra iron, turn first to greens and beans. Vitamin C–rich

foods, such as fruits and vegetables, increase the absorption of iron from the

otherfoodsyoueat,andavoidingdairyproductshelps,too.Theyareverylowin

ironandactuallyreduceitsabsorptionfromyourdigestivetract.

Zinc. Zinc plays important roles in immune function, wound healing, and

manyotherbiologicalfunctions,butaswithiron,you canhavetoomuchof a

good thing. The most healthful sources include legumes, nuts, and fortified

breakfastcereals(e.g.,PostGrape-Nuts,branflakes,andgranola).

Fat.Goodfats,badfats,andtoomuchfat—howdowemakesenseofitall?

The most important fat fact is this: Your body’s actual fat requirement is

minuscule,asyousawearlier.MostpeopleinWesterncountriesgetmanytimes

theneededamount.Withmeatsanddairyproductsfrontandcenterintheirdiets,

theynotonlygettoomuchfatoverall,theyalsogetthewrongkind—saturated

fat,whichboostscholesterolandaggravatesinsulinresistance.

Nuts,seeds,avocados,olives,andfull-fatsoyproductsarealsohighinfat.

Although they are low in saturated fat, the overall amount is high, and you

shouldlimitthesefoodsaccordingly.

Asyoualsosawearlier,mostvegetables,fruits,andbeanscontainverylittle

fat,andwhattheydohaveisahealthfulmixture,includingtracesoftheessential

fatsalpha-linolenicacidandlinoleicacid.

If, for any medical reason, you are increasing your oil intake, healthful

sources of omega-3 fats include walnuts, soy products, flaxseed, and, in

concentratedform,flax,linseed,canola,andwalnutoils.Healthfoodstoreseven

sell omega-3 supplements (e.g., DHA) drawn entirely from botanical sources.

Theyareabetterchoicethanfishoils.Omega-6oilsarealsosometimesusedfor

healthconditionssuchasarthritis,usuallyintheformofeveningprimroseoil,

borage oil, black currant oil, or hemp oil. They should be thought of as

medicinalsupplementsratherthanasfoods.

Inthenextchapter,youwillgetstartedwithyournewprogram,andthen,in

Chapter7,Iwillshowyouhowtotrackyourprogress.

Theglycemicindexofafoodisdeterminedbyfeedingaportioncontaining50gramsofcarbohydrateto

10healthypeopleafteranovernightfast.Bloodglucoseistestedat15-to30-minuteintervalsoverthenext

2hours,andtheresultiscomparedtofeedingthesameamountofglucose(or,insomecases,whitebread).

AGIbelow100meansthefoodhaslesseffectonbloodsugar,comparedtoglucose.Ahighernumber

meansthetestfoodhasagreatereffect.

CHAPTER5

HowtoGetStarted

Bynow,youunderstandtheprinciplesforbuildingahealthfuldietandareready

togetstartedwithfoodsthatwilltameyourbloodsugar,helpyouloseweight,

andgoalongwaytowardloweringyourbloodpressureandcholesterol.Butyou

arenodoubtasking,howdoIstart?Andwillitbeeasy?WillIbeabletostick

withit?

Let me put your mind at ease. The two-step system described in the last

chapter makes this very easy. You just take a week to “check out the

possibilities”andthendoa3-week“testdrive.”Let’srevisitthisinmoredetail:

STEP1:CHECKOUTTHEPOSSIBILITIES

Take aweek,and seewhichhealthy foodsyoulike best.Youare notgoing to

eliminate anything. Rather, you’ll try out new products, new recipes, and new

tastes, and perhaps get reacquainted with a few healthy tastes you may have

forgotten.

Takeoutasheetofpaperandjotdowntheheadings“Breakfast,”“Lunch,”

“Dinner,”and“Snacks.”overthenext7days,writedown—ineachofthefour

categories—foodsyoulikethatmeetthethreeguidelinessetoutintheprevious

chapter.Inanutshell,wearechoosingfoodsthatare:

Vegan. They contain no animal products. This means no meat, fish, dairy

products, or eggs—not even a little bit. The idea is to clean the animal fat,

animalprotein,and cholesteroloutof yourdiet.Ifyouskipped tothis chapter

andarewondering whythesestepsare important,pleasegoback andreadthe

precedingchapter.

Lowfat.Youwilluselittleornoaddedoilandomitotherfattyingredients.

If you are reading labels, choose foods with no more than 3 grams of fat per

serving.

Low glycemic index. You will favor low-GI foods. This means generally

avoidingsugar,whitebreadproducts,bakingpotatoes,mostcoldcereals,anda

few other foods. Most other vegan foods are fine. Certain foods have an

especiallylowGIvalue:beansandotherlegumes,greenleafyvegetables,most

fruits,barley(whichisgreatinsoups),andthemanyfoodsthataremadefrom

them.Surprisingly,pastahasalowglycemicindex,unlikeotherwheatproducts.

HealthfulBreakfastIdeas

Under“Breakfast,”yourlistmaywellbesimilartowhatyouareeatingalready.

Hereareafewsuggestions.

• Hot cereals such as oatmeal or other whole grain cereal with cinnamon,

raisins,and/orapplesauce(nomilk)

• Coldcerealssuchasbranflakeswithfat-freesoyorricemilkand/orberries,

peaches,orbananas

• Melon,cantaloupe,bananas,oranyotherfruit

• Ryeorpumpernickeltoasttoppedwithcinnamon(nobutterormargarine)

Ifyoulikeextraprotein,trythese.

• Veggiesausage

• Veggiebacon

• Scrambledtofu

• Breakfastburritosfilledwith“refried”beans,lettuce,andtomato(noeggor

cheese)

• Englishbakedbeansorchickpeas

• Pumpernickelbreadwithhummus

Hereareafewthoughtsaboutsomegoodbreakfastchoices.

Oatmeal. Most of our research participants make old-fashioned oatmeal a

partoftheirmorningroutine,andforgoodreason.Oatsarerichinsolublefiber

—thekindthatgetscreamyinwaterand removescholesterol fromyour body.

(Wheatand rice arehigh ininsoluble fiber.) Butthat humble bowl ofoatmeal

doesmorethanthat.Ithelpsbringyourbloodsugarundercontrol,anditshigh

fibercontenthelpsyouloseweight.

Anadditionaladvantagecomesfromwhatoatsdonothave:cholesteroland

animalfat.Abacon-and-eggsbreakfasthasastrikinglylargeamountofboth.

Generallyspeaking,old-fashionedoatmealisbetterthaninstantor1-minute

varieties,althougheven thesequick-cookingversions arefarbetter thanbacon

andeggs.Themoreintactthegrain,thelowertheGI,andthelongerthecereal

keepsyousatisfied.See“Old-fashionedoatmeal”fortipsonmakingtheperfect

bowlofhotoatmeal.

Foranextrabloodsugar–loweringeffect,topyourbowlwithcinnamon(see

“WhichSupplementsShouldYouTake?”fordetailsabouthowcinnamonaffects

bloodsugar).Oraddraisins,berries,orjustaboutanyfruitormixoffruitsyou

like,butsetthemilkandsugaraside.Withinjustadayortwo,youwillbreakthe

habitof addingthese unnecessaryand unhealthfultoppings. Ifyou justcannot

imagineoatmealwithoutmilk, splashonsomesoymilkorrice milk;you will

skiptheanimalfatandcholesterolofcow’smilk.

MostdrycerealshaveahighGI,butoatmealisinagoodGIrange,asisbran

cereal. They will keep you full and satisfied and help keep your blood sugar

steady.

Veggie sausage or bacon. Regular sausage and bacon are loaded with

cholesterol and fat and are among the most unhealthful foods on anyone’s

grocerylist.Butifyouareunabletoimaginebreakfastwithoutthesemeats,food

manufacturers have come to your rescue with vegan versions, and most

supermarketsandallhealthfoodstoresnowcarryseveralvarieties. Iftheyare

newtoyou,thinkofthemasaliberalinterpretationoftheoriginal;theyaretasty

andhighinprotein.Readthepackagelabels,andchoosethosethatomitanimal

ingredients(somearemadewitheggwhite,whichisconcentratedanimalprotein

thatyouwanttoavoid)andareaslowinfataspossible.

Scrambledtofu.Tofuisalmostidenticaltoeggwhite—ithaslittleflavorof

itsownbutquicklytakesontheflavorsofwhateverspicesorsaucesitiscooked

with.Scrambledtofuisagreatsubstituteforscrambledeggs—ithasallthetaste

but no cholesterol, animal fat, or animal protein. Supermarkets sell scrambled

tofu seasoning mixes, usually shelved near boxed rices or in the health food

section.Justfollowthepackagedirections.

Breakfastburritos.Notimeforbreakfast?Breakfastburritostotherescue.

Youbuythemfrozen,poptheminthemicrowave,andinacoupleofminutes,

youhaveahearty,healthybreakfast.Healthfoodstoresandmostregulargrocery

stores stock a variety of frozen burritos made with beans, tofu, tomatoes, and

other ingredients. You can also make your own, of course, perhaps on the

weekend, and refrigerate or freeze them so they are handy for those busy

mornings.

Bagels. If bagels are your thing, favor pumpernickel bagels, which have a

lowerGIthanwhitebagels.

AFewThingsNotontheBreakfastMenu

Just to state the obvious, eggs are off the list. A single egg has around 200

milligramsofcholesterol—similartoan8-ouncesteak—plusaloadofsaturated

fat,thekindthattendstoraisecholesterol.Thewhiteoftheeggpresentsabig

doseofanimalproteinthatyouwanttoavoid.Asyouknow,gettingyourprotein

from plant sources is better for your kidneys and your long-term bone health.

SkipeggsandeggreplacementssuchasEggBeaters,whicharemadefromegg

whites.

Ofcourse,breakfastmeatsareoffthelist,too,includingturkeysausageas

wellasporkorbeefvarieties.Theyallhavecholesterolandanimalprotein.

Forgetdoughnuts,Danishes, andmuffins.Toseewhy,set oneona napkin

forafewminutes,thenlookathowmuchgreasehasleachedout.Thatgreaseis

just waiting to fatten you up, boost your cholesterol, and worsen your insulin

resistance.

ABalancedBreakfast

You may wish to start your breakfast with a high-protein food such as veggie

sausage and follow it with a starchier food like oatmeal with cinnamon and

raisinsorasweetfoodsuchasfruit.It’snotthatyouneedextraprotein;thereis

actuallyplentyofproteininanytypicalmealbuiltfromvegetables,grains,and

beans.Here’swhystartingwithahigh-proteinfoodcanbehelpful.

Starchyorsugaryfoodsnaturallyincreasetheproductionofserotonin—the

same feel-good chemical that is boosted by antidepressants such as fluoxetine

(Prozac)andsertraline(Zoloft)—inthebrain.Now,that’sanicebenefit,butfor

somepeople,theresultispostbreakfastdrowsiness.Infact,somepeopleactually

use starchy foods as a remedy for insomnia. A high-protein food blocks the

serotonin-producing action, boosting your energy. Any high-protein food will

do:veggiesausage,veggiebacon,scrambledtofu,beans,orevenaspoonfulor

twoofchickpeas—thekindyou’dnormallythrowonasalad.

So,duringthisfirstweek,explorethevariousbreakfastpossibilitiesandjot

downyourfavorites.

Sample1-DayMenu

Breakfast

Veggiesausage

Ryetoast

Oatmealwithcinnamonandraisins

Slicedcantaloupe

Lunch

Greensalad

Splitpeasoup

Hummussandwichonryebreadwithslicedtomatoandcucumber

Dinner

Spinachsaladwithcherrytomatoes

Angelhairpastawithtomatoandmushroomsauce

Steamedbroccoli

Snacks

Apples,oranges,bananas

HealthfulLunchIdeas

Okay,let’smoveontolunch.Hereareafewideas,butyouwillnodoubthave

manymore.

Salads

• Gardensaladwithfat-freedressing,lemonjuice,orsoyorteriyakisauce

• Three-beansalad

• Pastasalad

• Blackbeanandcornsalad

• Grain-basedsalad,suchasnoodles,couscous,bulgur,orrice

Soups

• Minestrone

• Mixedvegetable

• Lentil

• Mushroombarley

• Blackbean

• Vegetarianchili

• Splitpea

• Instantandpreparedsoupsareokayaslongastheyarelow-fatandfreeof

animalproducts.

Sandwiches/Wraps

• CLT: sliced cucumber, lettuce, and sliced tomato on rye bread with Dijon

mustard.Oruseveggiebacon,ratherthancucumber,ifyoulike.

• Hummus on a whole wheat pita with grated carrots, sprouts, and sliced

cucumber

• Sandwich made with fat-free meat alternatives such as veggie turkey,

bologna, or pepperoni slices or barbecued seitan (wheat gluten), plus your

favoritesandwichveggiesonryebread

• Black bean dip, bell pepper and tomato slices, and lettuce wrapped in a

wholewheattortilla

• Italianeggplantsub:bakedeggplantslices,pizzasauce,andmushroomsona

wholegrainsubroll

• Blackbeanandsweetpotatoburritowithcornandtomatoes

Extras

• Freshfruit

• Chickpeas

• Cut-upvegetables

Hereareafewmoredetailsongoodlunchchoices.

Salads. Salads vary from the simple lettuce-and-tomato variety to pasta

salads,three-beansalads,Asiansalads,fruitsalads,andmanyothers.

If you start with salad greens, regular lettuce is fine, but do not shy away

frombabyspinach,arugula,andothergreens.Addcucumber,artichokehearts,

andtomatoslicesandbyallmeans,chickpeas,kidneybeans,orotherlegumesto

yoursalad.Theyprovideplentyofnutritionandaregreatatholdingyourblood

sugarsteady.

For convenience, supermarkets carry commercial three-bean and four-bean

saladsinjars,whicharereadywhenyouare.Manystoresalsohavewell-stocked

saladbars.

Whenyouchoosedressings,lookforfat-freeveganvarieties,whichareeasy

tofindatmanysupermarkets.

Soups.Soupisagreatlunchstarter,orabigbowlofheartysoupcanbeyour

lunch. Loaded with vegetables, beans, lentils, barley or other grains, and

wonderful flavors,soups are satisfying andwonderfully healthful.Ifyou cook

upabigpotontheweekend,youwillbereadyfortheweekahead.

If you are looking for convenience, Manischewitz brand dried soup mixes

aretime-savers.Justaddthemtoboilingwaterandletthemsimmer.Ifyoulike,

addtomatoes,greenchiles,oranyfrozenorfreshvegetables.Stiratablespoon

ortwoof nutritionalyeast intoeachbowlfor asavorytouch.Ifyou addextra

carrots, tomatoes, frozen vegetables (e.g., broccoli, kale, cauliflower, or green

beans),andspices,youwillturnyoursoupintoastew.

If you’dliketo let someone elsedo the cooking, your supermarkethas an

endless varietyof cannedandfrozen soups. You need tobe selective, butyou

willfind plentythat meetour requirements.Lentil, minestrone,and vegetarian

vegetablearegoodchoices.Tabatchnickfrozensoupsoffergenerousservingsof

split pea, mushroom barley, and other flavors with simple ingredients and

virtuallynofat.

Instantsoupcomesinacupandjustneedshotwater.Youmightkeepafew

cupsinyourdeskdrawerforemergencies.

To have homemade soup anywhere, pick up an insulated bottle, such as a

Thermos,soyoucanjustfillitwithsoupandtakeittowork.Yourco-workers

willwishtheyhaddonethesame.

Onecaveataboutpreparedsoups:Somemanufacturersoverdoitwithsalt,so

it pays to choose lower-sodium brands. Aim to keep your total daily sodium

intaketolessthan1,500milligrams.

Sandwiches. Sandwiches are quick and portable, and with the enormous

varietyofingredientsavailablethesedays,theycanbehealthful,too.

Startwithalower-GIbread,suchasryeorpumpernickel.Tryanyorallof

thefollowingfillings.

Hummus is a Middle Eastern dish that has become popular in North

America. It is made from chickpeas and spices and has a texture vaguely

reminiscent of peanut butter but a milder flavor. Unfortunately, many

commercial brands are too high in fat, but who needs them? With a food

processor,ittakesonlyabout5minutestomakeyourown,andabigbatchwill

lastfordays.

Meatlessdelisliceshaveallthetasteofbologna,slicedturkey,orhamwith

noneoftheanimalfatorcholesterol.Theyaresoldatallhealthfoodstoresand

manysupermarkets,andtheymakegreatsandwiches.Youcanfindthemnextto

thevegetarianhotdogs,whicharealsogreatchoices.Asalways,chooselower-

fatbrands.

Veggieburgersareeasytomake,andcommercialbrandsarewidelysoldin

storesandrestaurants.Tryafewdifferentbrands,andfindyourfavorites.Favor

thosethatarelowestinfat.

A BLT made with veggie bacon, lettuce, tomato, and mustard is a great

choice.My own keep-it-simplesandwich isa CLT, madeon toasted ryebread

withlettuce,slicedcucumberandtomato,sometimesavegandelisliceortwo,

andtoppedwithDijonmustard.

Speakingofcondiments,mustardisfat-free;makeityourspreadofchoice.

Mostmayonnaisespreadsarejusttheopposite—theyareloadedwithfat.There

arenowmanyveganmayosonthemarket,buttheyarenotnecessarilylowin

fat.Checkthelabels.

Frozenmeals.TheTVdinnerhasgrownup.Theamazingvarietyoffrozen

foods,plustheconvenienceofmicrowaveovens,makesiteasytoeathealthful,

tastyfoods.Somefavoritesincludeveganenchiladaorburritodinnersandpizza

orpastadishes.

Iflunchmeansdiningout—orperhapsfastfood—seeChapter8forhealthful

restaurantchoices.

HealthfulDinnerIdeas

Thereisalimitlessarrayofhealthfulfoodsfordinner,whetheryouliketocook

ornot.Manypeopleenjoycooking,butmanyothersfeeltoobusyorjustcannot

be bothered; they tend to choose simple and convenient foods or eat out.

Personally,Ifallsquarelyintothesecondgroup.

Thegoodnewsisthatbothtemperamentsdoverywellinthisprogram.Here

areafewideasforstarters.

• Pastamarinara:Manycommercialsaucesarefine.Choosethoselowestinfat

and free of cheese and other animal products. Add some mushrooms,

artichokehearts,orbroccolior spinach(prepared freshor frozen),and you

willbeset.

• Beansandrice:TryCubanblackbeanswithsalsa,vegetarianbakedbeans,or

“refried”beans.

• Softtacos:Startwithawholewheattortillaandaddbeans,lettuce,tomato,

andsalsa.

• Chili:Vegetarianboxedversionsarefine.

• Veggie lasagna: Use low-fat tofu to replace the ricotta, and add layers of

grilledveggies.

• Ricepilaf,Spanishrice,orpackagedricedinners:Manycommercialbrands

arefine,butomitthebutter.

• Friedriceandvegetables:Useanonstickpanandseasonthismealwithlow-

sodiumsoysauce.

• Fat-freeveggieburgers:Readthelabelsandchoosethoselowestinfatand

freeofcheeseandotheranimalproducts.

• Fajitas:Lightlysautéslicedbellpeppers,onion,andeggplantinanonstick

panandaddfajitaseasonings.

• Stewmadewithchunkyvegetablesinasavorysauce

• Mushroomstroganoff

Ourjobfornowisnottomakeyouintoachef,butsimplytomakearealistic

1-daymenuoffoodsyoureallywilleatandenjoy.

Itpaystothink“international.”manycuisinesfrom aroundtheworldhave

greatchoices,whetheryoumakethemyourself,havethematrestaurants,orbuy

them frozen: Mexican bean burritos, Italian pastas and bean soups, Chinese

vegetableandricedishes,Japanesevegetablesushiwithmisosoupandsalads,

Indiancurries,Thaidishes,Ethiopiancuisine,andmanyothers.Thesefoodstake

advantageoftherichtraditionofplant-baseddietsinmanycountries.

Ifyourideaofdinnerissendingoutforpizza,itcanstillbeveganandlowin

fat. Just ask for all-vegetable toppings, such as mushrooms, peppers, onions,

sun-driedtomatoes,andcapers.Holdthecheeseandaskforextratomatosauce

instead.Ifyouaremakingpizzaathome,youcanaddveggiepepperoniorother

delislicesifyoulike.Foracheesytaste,sprinkleonsomenutritionalyeast.

ABalancedDinner

Agoodwaytomakesureyourdinneriswellbalancedistofillaboutaquarterofyourplatewith

alegumedish.Thatmeansbeans,peas,orlentils.Soyoumightchoosebakedbeans,abean

burrito, or black-eyed peas, for example. These foods are rich in protein, soluble fiber, and

mineralsandhavewonderfullylowGIs.

Next, fill another quarter of your plate with a starchy food such as brown rice, a yam, or

pasta.Starchisanunglamorousword,butitreallymeanscomplexcarbohydrate—thehealthy,

clean-burningfuelthatpowersyourbody.

Finally, fill the remaining half of your plate with vegetables. Ideally, choose two different

varieties—say, a green vegetable like broccoli and an orange vegetable like carrots. These

foodsareyournutritionpowerhouses.Addfruitfordessert,andyouwillbeset.

Youcanvarytheseproportionsifyoulike.Aslongasyourplateisvegan,lowfat,andlow

GI,youwillbefine.

There are a million ways to do this. Some people like an Italian or Mediterranean meal,

whichmightincludebeansoupandpastawithachunkyvegetablesauce.OtherspreferLatin

Americanmeals,withbeans,rice,andvegetables.SomemightfavoranAsiandinner,withtofu

(whichcountsasalegumebecauseitismadefromsoybeans),rice,andvegetables.AnIndian-

inspiredplatemightincludealentilcurrywithriceandvegetables.

ForAmericansfromSouthernstates,manytraditionalfoodsfitthebillbeautifully:beansor

black-eyedpeas,rice,andgreens(withoutthetraditionalfatback).

WhenmyNorthDakotaparentsdecidedtoimprovetheirownwayofeating,wesubstituted

abeandishandvegetablecutletsfortheusualmeatdishandaddedyamsorsweetpotatoes,

alongwithacoupleofvegetablechoices.Dessertwaspears,strawberries,ororanges.Seethe

pattern?It’sstillthere:abeandish,astarchyfoodforhealthycarbs,vegetables,andfruitfor

dessert.

SimpleSnackIdeas

okay,yourday’smenuisnearlycomplete.Butevenifyoufeelyouwillnotbe

hungrybetweenmeals,pencilinafewsnackideassoyouwillbereadyincase

themunchiesdohit.A3:00p.m.Hungerpangcanerodeyourresolve,sostock

up on things that you can feel good about eating. Here are some snack

suggestions.

FruitshaveasurprisinglylowGIinmostcases,andtheyareunbeatablefor

nutritionalvalue.Keepapples,oranges,pears,bananas,andotherfruitsonhand.

Some people like to keep a bowl of cantaloupe and melon chunks in the

refrigeratorforaninstantsnackthat’s readywhen theygethome.Don’tforget

tropical favorites, like mangoes and papayas. Dried fruits are acceptable.

Surprisingly, their GIs are not necessarily higher than those of fresh fruit.

Becausetheir waterhas beenremoved, however, itis easyto takein farmore

calories with dried fruit than with fresh fruit, so it pays to favor the fresh

varieties.

Instantsoupsaregreattokeepinyourdeskdrawer;justaddhotwaterwhen

youarereadytoeat.Minestrone,splitpea,lentil,andothervarietiesaretypically

veganandlowinfat.

A simple CLT—the sandwich of lettuce and sliced cucumber and tomato

withmustardonryebreadImentionedabove—willfillyouup,withnothingto

regret.

Three-beansaladwillholdyouuntildinner.

Air-poppedpopcornskipsthefatoftheusualkind.Topitwithgarlicsalt,

mixedseasonings(e.g.,Spike),ornutritionalyeast.

Hummus on a whole wheat pita is filling and low in fat if you make it

withoutaddedoil.

Othersimplesnacksincludebrancerealwithsoymilk,pumpernickelorrye

toast with jam, carrot sticks, and rice cakes (look for simple, unsugared

varieties).

STEP2:A3-WEEKTESTDRIVE

Allright,youaredoinggreat!Youhavemadegoodchoicesthatwillgiveyoua

healthystart.Now,let’stakea3-weekperiodand,duringthattime,let’smakeit

allveganallthetime.Thatmeansnoanimalproductsatall,keeptheoilslow,

and favor healthy, low-GI foods. At this point, that will be easy, because you

pickedoutthefoodsyoulikeduringweekone.Noneedtowhipupsomething

neweveryday.Itisfinetorepeatitems,useleftovers,ormakeyourlifeeasyin

anywayyoucan.Remember,though,donotlimitcaloriesorskipmeals.

Itisessentialtoberealistic.Ifyoudonotenjoycookingnow,thatisunlikely

tochange.Plantohavefoodsonhandthatrequirelittlepreparation.

Will you be at work? Traveling? Planning ahead is essential. If there is

nothing healthful in the company canteen, you will want to pack a lunch.

Sometimes when a colleague asks what I am having for lunch, I answer, “les

restes d’hier.” This sounds exotic until I explain that the phrase is actually

French for “leftovers.” But the fact is, my leftovers sometimes are exotic,

dependingonwhichrestaurantfilledthedoggiebag!

Let’sGoShopping

It pays to stock your shelves with the foods and ingredients you will need so

your3-weektestdrivegoessmoothly.Andwhenhungerhits,youwillbeready.

Take a trip down those aisles at the supermarket that you may well have

neglectedinthepast.The producedepartmentmaystockmeatsubstitutes,soy

milk,andotherhealthyproducts,alongwithanever-growingarrayofnewand

interesting fruits and vegetables. Also check out the “international,” “health,”

and“dietetic”aisles.Andlookattheshelveswithinnumerablevarietiesofrice

andcolorfuldriedbeans.

Besuretocheckoutyournearesthealthfoodstoreifyouhavenotdoneso

already.Youwillfindsubstitutesformeatandmilkandinterestingfoodsfrom

other countries, all worth a try. Explore and experiment; some new finds will

becomefavorites.Iftheoccasionalpurchaseturnsouttobeadud,donotworry.

Thatiswhatexperimentingisallabout.

Asyoushop,pickupingredientsthatwillallowyoutoprepareafewextra

thingsontheweekend—apotofsouporstew,forexample—thatyoucanthen

splitintoportionsforquickreheatingduringtheweek.

You will notice that prices for healthful foods vary widely. Overall, plant-

basedfoodsarelessexpensivethanmeatyorcheesyproducts.Beans,freshand

frozen vegetables, pasta, rice—these humble ingredients cost very little.

However, health food stores sometimes put premium prices on prepared

products,whichistruefornonvegetarianaswellashealthfulveganitems.You

willsoonsortoutyourbestchoices.

Whileyouareatthestore,pickupavitaminB

supplement,andifyoudo

notgetregularsunshine,purchaseavitaminDsupplement,too.

SomeStaples:BasicFoodstoTasteandTry

Thereareafewbasicfoodsthatwouldbegoodforyoutogettoknow.Theyare

notelaborate—justsimple,basicstaplesthatoughttobeonyourshelves.Ifthey

arenew toyou, theywill behealthful additionsto yourrepertoire. Letme list

somehereandencourageyoutothinkaboutthemwhenshopping.

Old-fashionedoatmeal.Choosethisvarietyratherthaninstant,andseehow

easyandfastitistomake.Justcombine1partoatmealwith2partscoldwater,

bringtoaboil,andsimmerforafewminutes.That’sallthereistoit.Oatmealis

loadedwith solublefiber tobringyour cholesteroldown andfillingenough to

keep hunger at bay all morning. While you are at the store, pick up some

toppings:cinnamon,raisinsorotherfruit,orwhatevercallstoyou.

Beans.Gettoknowthemanyvarietiesofthishumblefood.Verylowinfat;

devoid of cholesterol; high in soluble fiber, calcium, and iron; and with an

enviableglycemicindex,beans’dayhasarrived.Cookthemupfromscratchif

you like, but it’s handy to stock your shelves with a couple of cans of black

beans(and ajarofsalsa),fat-free “refried”beans,and anyother varietiesyou

see.

Frozenvegetables.Convenienceisthewordhere.Ifyouaretheslightestbit

pressedfortime,youwillbegladyouhavevegetablesinyourfreezerthatjust

need a little steaming. Nutritionally, frozen vegetables are equivalent to fresh.

Look for broccoli, winter squash, petite Brussels sprouts, carrots, cauliflower,

andanythingelseyoufancy.

Lentilsoup.Lentilsassertthemselvesinaheartyandhealthfulsoup.Keepa

canortwoonhand.

Hummus. As I mentioned above, thissimple chickpea dip has become an

enormouslypopularsandwichfilling.Butskipthecommercialbrands,whichare

toohighinfat.Ifyouhaveafoodprocessor,youcanmakeyourowninlessthan

5minutes,andyouwillbesetfortheweek.

Chickpeas.Speakingofchickpeas,thisisonelegumethatisreallyathome

justaboutanywhere—notjustashummusbutalsoinsalads,soups,pastasauces,

and stir-fries. You can even eat them for breakfast. Keep a few cans on your

shelf;theextra-smallcanswithpop-toplidsareespeciallyconvenient.

Toppings.Dijonmustardisgreatforsandwiches,andlemonjuiceorapple

cidervinegaris greaton green vegetablesand salads. Salsawas just madefor

beans,andfat-freedressingsofanyvarietyarehandy,too.

Brownrice.Mostpeoplehavenevertastedaproperlypreparedbowlofrice.

The trickis to selectbrown rice, toastit slightly, and cook itlike pasta, using

whatmayseemliketoomuchwateranddrainingawaytheexcessattheend.

Barley.Thisgrainisalloverthebreakfastcerealaisle,inpuffedandsugared

form,butbarleyreallyshinesinsoupsorwhenservedasagrainsidedish.You

canmixitwithriceandcookthemtogether.BarleyhasalowGI,lotsofsoluble

fiber,andwonderfultasteandtexture.

Spaghettisauce.Takeafewminutestoreadlabelsonjarsofmarinarasauce

tofindvarietiesthatexcludecheeseandotheranimalproductsandkeepoiltoa

minimum. Then stock your shelves for a quick and easy dinner. Pick up your

favoritepastatogowithit.

Meat substitutes. Try the veggie versions of hot dogs, burgers, and deli

slices. They are not haute cuisine, but they serve a useful purpose, and some

tastesurprisinglysimilartothefoodstheyimitate.Readthelabels,though,and

skipproductswithanimal-derivedingredientsormorethan2to3gramsoffat

per serving. Health food stores have a huge selection, and many regular

supermarketscarrythem,too.

Nutritionalyeast. You canfindthis inthesupplement aisleathealthfood

stores. Nutritional yeast dissolves into spaghetti sauces, stir-fries, casseroles,

soups, andlots of other recipes,adding a subtle cheese-liketaste. It isnot the

sameas brewer’s yeastor baker’syeast, both ofwhich taste bitter. Nutritional

yeast comes in flakes and powder. For better texture and versatility, buy the

flakes.

Freshfruit.Freshfruitis aperfectsnack,and youwillwantto keepiton

hand.Buyextraforfriendsandfamily.

ChecktheLabel

Therearetwothingsyouwanttolookforonproductlabels.First,checktheingredientslistto

makesure there are no animal-derived ingredients. Common ones includemilk solids, whey,

casein(andvariouscaseinderivatives,suchassodiumcaseinate),eggproducts,andgelatin.

Alsobeonthelookoutforpartiallyhydrogenatedvegetableoils,whichareasbadassaturated

fat.

Sometimespeople want tomake exceptions forfoods that soundas if they are healthful.

Honey,forexample,hasgottenunjustifiedgoodpressoverthedecades.Nutritionallyspeaking,

it is simply sugar, offering you nothing from a health standpoint. Rather like olive oil, its

marketinghasgottenwayaheadofitsvalue.

Next,check the NutritionFacts.Ideally, a servingof food will haveno more thanabout 3

gramsoffatandshouldhavezerocholesterol.Ifthecholesterolcontentisanythingotherthan

zero, the product contains some animal-derived ingredient. If label reading seems a bit

cumbersome, keep in mind that you need to check a product only once. As you find the

productsthatfitthebill,there’snoneedtocheckthemagain.Also,simplefoodsdonotneed

labels.Nooneeverhadtolookforthefineprintonabananaorpear,aboxoffrozenspinach,

orabagofnavybeans.Eachofthesefoodshasexactlyoneingredient.

WhattoDowithUnhealthyFoods?

So you have filled your shelves and refrigerator with healthy staples. If some

not-so-healthfulitemsfromyourpreviousdietarestilllurking,though,whatdo

youdo? That’s easy:getridofthem. Donot“use themup”because theywill

continue to cause problems for you. Toss them. And if family members or

roommates share your kitchen space, avoid keeping tempting foods too near

yourown.Theywillpresentmoreofatemptationthanyouneed.

PlanningAhead

Eventually, healthful eating will become second nature. For now, though, you

will need to put a bit of thought into where you will be at lunchtime and

dinnertimeandwhat youwillhave.Therereally arehealthychoicesoutthere,

buttheyaresometimesnotsoobviousinaculturethatcaterstounhealthytastes.

Ithelpstoplanahead.

ONYOURMARK,GETSET…

Aswe’vediscussed,youwillwanttopickouta3-weekperiodandreallydive

intothisnewmenu.Chooseatimewhenyouhavethementalenergytoembrace

achange.Ifyouareanaccountant,April14probablyisnotagoodtime.Ifyou

areastudent,examweekmaynotbethebestchoice.Butonceyouhavepicked

yourtime,jumpinwithbothfeet.Dothedietchange100percent.Followour

threeguidelinesascloselyashumanlypossible,anddoitalltheway.

Okay, you havedonegreat. You havethe basics down.In the nextseveral

chapters,wewilllookatspecifichealthissuesandsituationsyoumayencounter,

andIwillofferplentyoftipsforhandlingthem.

CHAPTER6

HealthfulWeightControl

Ifyouhavebeenaimingtoloseweight,letmeshowyouthestepsthatmakethe

process as easy, effective, and permanent as possible. Eliminating unwanted

pounds is important for anyone—but especially for people with diabetes. For

starters,itboostsyourinsulinsensitivity;themorebodyfatyoutrimaway,the

moreresponsiveyourcellsaretowhateverinsulinyourpancreasisproducing.

Weightlossalsobringsdownyourcholesterolandbloodpressure.Andwhen

you’vetrimmedawaybodyfat,exerciseisthatmucheasierandmoreinviting.

Yourjoints—especiallyyourknees—willthankyou.

Needlesstosay,thereareagreatmanywaystoloseweight.Cuttingcalories

worksforsome people,butothersfind itarealchallenge.Ifyou normallyeat

2,000caloriesperday,forexample,acommonrecommendationwouldlimityou

to1,500—andthatgetsoldveryfast.Ifyou’rehungryat8:00intheeveningand

you’vealreadyhadyour1,500caloriesfortheday,youwillgotobedhungry.

Thatwillneverhappenontheprogramrecommendedinthisbook.

A healthy approach to weight loss focuses on choosing the right kinds of

foods,not onthe quantityof food you eat. Whenyou have the right foodson

yourside,thecaloriesandportionsfallintolineontheirown,andweightlossis

almostautomatic.

AWEIGHT-LOSSDIETTHATWORKS

In2005,myresearchteampublishedtheresultsofanimportantstudythattested

anewandpowerfulapproachtoweightloss.Theparticipantswerewomenwith

moderatetosevereweightproblems.Mosthadtriedmanydifferentdiets:low-

calorie diets, low-carbdiets, Weight Watchers, the cabbage-soup diet, andjust

about everything else. Like most people, they had found these diets tough to

follow,andwhateverweighttheylostsoonreturned.

Ourapproachwasvery different.Itdid notincludecaloriecounting,limits

on portions or carbohydrates, or even an exercise prescription. For research

purposes,wewantedtoisolatetheeffectsofdiet.

The participants lost weight easily, averaging about 1 pound per week—

weekafterweekafterweek—andtheykeptitofflong-term.

Otherresearchers

havefoundmuchthesamething.

Whyisaplant-baseddietsopowerfulforweightcontrol?Well,firstofall,it

isimportanttounderstandwherethecaloriesarehidinginthefoodsyoueat.A

chickenstoresextracaloriesinchickenfat.Acowstorescaloriesinbeeffat.A

fish stores them in fish fat. Body fat—in humans or animals—is a calorie-

storagesystem.

Ifyouweretoremoveabitoffatfromadrumstickorchickenwingandsend

it to a laboratory, you would find that a gram of fat—that’s

⁄

 ounce—has 9

calories. That is a lot. It is more than double the calories in a gram of

carbohydrate—the starch in rice, beans, or sweet potatoes, for example.

Carbohydrates have only 4 calories per gram. Small wonder that people who

makericeorotherplantfoodstheirstaplestendtostayslim.ThroughoutAsia

andruralAfrica,riceandothergrains,rootvegetables,andvariouslegumesare

thetraditionalfoundationofthediet.Thesefoodsarefillingbuthaverelatively

fewcalories.

Ofcourse,it’sadifferentstoryinNorthAmericaandEurope,wheremeals

feature meat and dairy products, which contain the very fat that animals have

used to store their excess calories. Weight problems are the all-too-common

result.Ifyouwanttoavoidtakinginextracalories,youwoulddowelltoavoid

eatingtheconcentratedcaloriesthatanimalshavehiddenawayintheirbodyfat.

So,steponeistoavoidanimalproducts.Ifyoudothat,youwillofcourse

avoidanimalfatcompletely.

Steptwoistokeepvegetableoilstoaminimum.Beans,grains,vegetables,

fruits, and most other foods from plants have very little fat. There are a few

exceptions,however:nuts,seeds,avocados,andsomesoyproductsarehighin

fat.Keepthemtoaminimumaswell.

Be especially careful about vegetable oils used in cooking or in salad

dressings.Now,somepeoplearguethatplantoilsaremorehealthfulthananimal

fats,andit’struethattheyaremuchlowerinsaturatedfat,thekindthatraises

cholesterollevelsandislinkedtobreastcancerandinsulinresistance.Whenit

comes to weight problems, however, animal fats and vegetable oils are

essentiallyallthesame.Theyallpackin9caloriespergram.

Step three is to focus on high-fiber foods. A grain of brown rice, for

example, hasa thin cloak of fiberthatgives the rice itstan color. To produce

whiterice,manufacturersstrip awaythiscoating,but youarebetteroffifitis

leftintact.Fiberfillsyouupsoyoufeelnaturallysatisfiedwithfewercalories.

AsyousawinChapter4,every14gramsoffiberaddedtoyourdailymenu

cuts calorie intake by about 10 percent on average.

 That simply means that

high-fiberfoodsfillyouupfaster,soyoustopeatingsooner.Insteadoftryingby

sheer force of willpower to cut calories, you cut them without even thinking

aboutit.

Therichestsourcesoffiber arebeans, vegetables,fruits, andwhole grains.

Whilebreakfastcerealcommercialstendtopushgrainsasthebestfibersource,

youwillfindmuchmorefiberinbeansandmostvegetablesthaninmostgrains.

Buttheyalladdup.Aimforatleast40gramsperday.Onecaveat:Ifhigh-fiber

foods, especially beans, have not been part of your routine, you’ll want to

increasetheamountyoueatgraduallytogiveyourdigestivetracttimetoadjust.

SeeChapter9formoretipsonavoidingdigestiveproblems.

Inthenextchapter,Iwillshowyouaneasywaytocheckyourfiberintake

usingtheQuickFiberCheck.

Okay,let’ssummarize:Toloseweight,youwanttoavoidanimalproducts,

limittheuseofvegetableoils,andgohighfiber.Vegetables,fruits,wholegrains,

andbeansfitthebillperfectly.

StepstoWeightLoss

1. Avoid animal products. If you steer clear of fish, chicken, beef, dairy foods, and all other

animalproducts,youwillcutyouranimalfatintaketozero.What’smore,thisshiftwillmean

thatyouwillnaturallyeathigh-fiberfoodstoreplacethosefromanimalsources,whichhave

nofiber.

2. Keepvegetableoilstoaminimum.Ifyouhaveabottleofcookingoilinyourkitchen,throwit

away.Therearesimplerandbetterwaystocook.Alsolimitnuts,seeds,avocados,andfull-

fatsoyproducts.

3. Favorhigh-fiberfoods.Buildyourmealsfrombeansandotherlegumes,vegetables,fruits,

andwholegrains.

Toensurecompletenutrition,besuretohaveavitaminB

supplementeachday.

HEALTHYEXAMPLES

By now, you already have a good idea of what this looks like on your plate,

becausethedietchangesforweightlossareverymuchlikethoseforcontrolling

yourbloodsugar.Breakfastmightstartwithveggiesausageorveggiebacon—

thatis,fauxmeatsmadeofsoyorwheat—followedbyabigbowlofoatmealor

perhaps some fresh fruit. You would skip bacon, eggs, and ordinary bagels,

whicharestrippedoffiber.

Lunchcouldbeasandwichmadewithslicedtomato,lettuce,andveggiedeli

slicesonrye,orapastasaladwouldbefine,too.

Fordinner,youmighttrytomatoorsplitpeasoupfollowedbyavegetable

stir-fryorshepherd’spiefilledwithchunkyvegetables.Intheprocess,youwill

avoid animal fat, have very little vegetable oil, and get all the fiber in those

healthyvegetables.

For a between-meal snack, an apple or banana fits the bill nicely, while

potatochipsornutspacktoomuchfat.

Vance

WhenVancejoinedourstudy,hewantedtogethisweightdownto210to225

pounds.Since heinitially weighedinat276pounds, hehad aways togo. He

stucktothedietprogram,however,notworryingaboutcaloriesorportionsbut

payingcloseattentiontothetypesoffoodhechose.Everythingwasveganand

lowinfat.Also,inordertogivethedietagoodtest,heagreednottoaddany

exerciseforthefirst6months.

Thepoundsstartedtocomeoff.Threemonthslater,heweighedinat251—a

lossof25poundsinabout12weeks.Friendscouldn’thelpbutnotice,andmany

askedhimwhathissecretwas.After6months,hewasdownto238.Atthe14-

monthmark,hewasat217.

Nancy

Nancybeganthestudyat197pounds.LikeVance,shechangedherdietbutkept

heractivitylevelthesametoallowustotestwhatthedietchangealonecould

do.Threemonthsintotheprogram,herweightwasdownby14pounds.After6

months,shehadlost25pounds,andat14months,sheweighed155pounds—a

lossof42poundswithoutcountingcalories.

NotExactlyHealthFood

Afewyearsago,Iwasrunningastudyondietandweightlossandfoundthatacoupleofour

participants were chowing down on Twizzlers—the red candy that comes in long twists like

licorice.WhenIasked why they were eatingcandy,theypointedout that the product is both

vegan and low in fat. And sure enough, there’s a friendly message printed on a package of

TwizzlersStrawberryTwists:

Didyouknow…

Strawberry Twists are a low-fat candy! That’s right, the same great-tasting

Twizzlersyouhaveknownandlovedarelowinfat,asalways.Nothinghaschanged.

Alookattheingredientslistshowsthat,indeed,nothinghaschanged.Likeothercandies,it

isbasicallyasugaryconcoctioncontainingnothingthatyourbodyevenremotelyneeds.Sugar

isnowherenearashighincaloriesasfat,butitstillprovidesmorecaloriesthanyouneed.

FOODSTHATWORKMAGIC

These simple foods have surprising effects. Not only do they help you trim

hundredsofcaloriesoffyourdailymenu,theyalsocauseafundamentalchange

withinthecellsofyourbody.AsyousawinChapter2,clinicaltestshaveshown

thattheyincreaseyourbody’safter-mealcalorieburn.Thereasonisthis:Asyou

change your diet, your insulin sensitivity begins to improve. That means that

glucosehasaneasiertimeenteringyourcellstobeburnedforenergy,ratherthan

continuingtocirculateinyourblood.

Theafter-mealcalorieburnissmall,butit

lasts for3 or more hours after eachmeal, giving you an extraedge for losing

weight.

APPETITECONTROL

BarbaraRolls,PhD,aresearcheratPennsylvaniaStateUniversity,hasproposed

aninnovativewayofthinkingaboutappetitecontrolbasedonaconceptcalled

energydensity.

Herstudieshave lookedat whattriggers satiety—thesense of

fullness after meals—and shown how to plan meals to bring on a feeling of

satietyearlier.

Surprisingly,whatmakesusstopeatingdoesnotseemtobethenumberof

calorieswehave ingested,nor isittheamount ofcarbohydrateorprotein ina

meal.Rather,itistheweightoffoodwehavetakenin.Itisasifyourstomach

hasa scale,and onceit registersa certainnumberof gramsof food,it signals

yourbrainthatyouhavehadenough.

Wealltendtoeatroughlythesameweightoffoodeachday.Ifyourmeals

donotaddupastheynormallydo,yourappetiteguidesyoutohavealittlemore.

There’saneffectiveweight-lossstrategyinthere.Ifthefoodsyoueatcontain

afairamountofwater—soupsorfruit,forexample—theyareheavyenoughto

tipyour“stomachscale”andreduceyourappetite.Becausetheweightofthese

foods comes mainly from water, which has no calories, they tend to cut your

totalcalorieintakefortheday.Thesefoodshavealowenergydensity.Thatis,

theyhaverelativelyfewcalories,eventhoughtheymighthaveenoughweightto

convinceyourstomachthatyou’veeatenquitealot.

Oneimportantcaveat:Forsomereason,simplydrinkingwaterwillnotturn

offyour appetite.Your stomachapparently reactsdifferentlyto heavyfoods—

whichtriggeranappetiteshutoff—thantoadrinkofwater,whichdoesnot.

Dr. Rolls proved this with an interesting lunchtime experiment. When

researchvolunteersateacasseroleappetizeralongwithaglassofwater,theyate

about400caloriesatlunch.Inaseparatetest,however,shestirredtheglassfulof

water into the casserole to make soup. When she measured the participants’

calorieintakeafterward,shefounditwascuttolessthan300.Thesouptricked

theirstomachsintoshuttingofftheirappetites.

Herearesometipsforreducingtheenergydensityofyourmeals.

• Soupsareagreatchoice.Theyarefillingbutgenerallylowincalories.Favor

clear,low-sodiumsoupsratherthancreamyvarieties.

• Addtomatoes,chickpeas,cucumbers,peppers,andothervegetablestoturna

salad into a meal while keeping it low in calories. Use fat-free dressing,

lemonjuice,orapplecidervinegarratherthanregularoilydressings.

• Apples,oranges,pears,mangoes,papayas,berries,andmostotherfruitsare

excellentchoicesforsnacks,desserts,orameal.

• Vegetables of virtually any variety are good choices. Adding chunky

vegetables to salads and casseroles reduces their energy density in a very

helpfulway.

• Beandishesarefilling,butsurprisinglymodestincaloriesiftheyaremade

withoutaddedfat.Thinkofchiliandcasseroles.

• Goforwholegrains.Ricebeatsricecakes.Pastabeatsbread.Ineachcase,

oneis water-based andfilling,while theotheris airyandnot fillingatall.

Old-fashionedoatmealisagreatbreakfastchoice.

Includingthesefoodsgenerouslyinyour menuwill accelerateyour weight

loss. There’s an easy way to check the energy density of commercial food

products: Just take a look at the label. If one serving has fewer calories than

grams, it is a good choice. For example, the label on a can of black beans

(below)showsthataservinghas90caloriesandweighs122grams,sothebeans

areagoodchoice.

BlackBeans

NutritionFacts

ServingSize½cup(122g)

ServingsPerContainerApprox3½

AmountPerServing:Calories90,CaloriesfromFat5

A can ofspinach has 30 calories and115 grams per serving, so it’s also a

winner.Eachofthesefoodshaslessthan1caloriepergram,sotheweightofthe

foodfillsyouupbeforethecaloriesfillyouout.

What about skinless chicken breast? One serving has 173 calories and

weighsabout100grams(3.5ounces).Notagoodchoice.Asidefromnotbeing

veganorparticularlylowinfat(23percentofcalories),ithasfarmorecalories

thangrams.

A slice of bread may have 80 calories and weigh 32 grams. It has few

calories but is very lightweight, so it is not filling. With more calories than

grams,itisnotespeciallyhelpfulforweightloss.

I am not suggesting that you use energy density in place of the other diet

guidelinesinthisbook.Useitinadditiontothisprogramtorampuptheweight-

loss power of your new menu. It will help you pick from among the allowed

foodsthosethatarethemostfillingwiththefewestcalories.

Again,theideaissimplytoreducetheenergydensityofthefoodsyoueatby

choosingthosethat naturallycontain afairamountof watertofillyou upand

shutoffyourappetite.

STEERCLEAROFLOW-CARBDIETS

Low-carbohydratedietsarepopular,onandoff.Buttheyarepotentialdisasters

for anyone, especially for people with diabetes. They often bring short-term

weight loss, but most of the weight quickly returns. Low-carb diets also have

wildlyunpredictablehealtheffects.Inresearchstudies,asmanyasone-thirdof

low-carbdietershaveshownasignificantincreaseinLDL(“bad”)cholesterol.

Somehavehadsuchhighcholesterollevelsthattheyhavebeenforcedtodrop

outofstudies.

What’smore,low-carbdietsareusuallyhighinprotein.Theanimalprotein

that is commonly emphasized in these diets can be hard on your kidneys.

Harvardresearcherstrackedkidneyfunctionin1,624womenparticipatinginthe

Nurses’HealthStudy,focusingespeciallyonthosewhohadanylossofkidney

functionatthestartofthestudy.Itturnedoutthatthemoreanimalproteinthe

women consumed, the more kidney function they lost.

 Given that about 40

percentofpeoplewithdiabeteshavealreadylostsomekidneyfunction,itmakes

goodsensetoprotectyourselfagainstfurtherdamage.

Istronglycautionagainst

anydietsthatrecommendhigh-proteinfoods.

As you have seen, such diets arebased on the outdated idea that avoiding

carbohydratesisthekeytoglucosecontrol.Asyouknowbynow,populations

that make rice, noodles, and other carbohydrate-rich foods their diet staples

actuallyhavehadverylittleobesityandverylittlediabetes.

Sometimes,whenpeopleblame“carbs”fortheirweightproblems,theyare

thinking of cookies and cupcakes. But if you have ever looked at recipes for

theseproducts,youknowthatanenormousloadoffat—typicallyfrombutteror

shortening—is usually lurkinginside. So the carbohydrate in theseproductsis

reallyaninnocentbystander;it’stheirloadoffatthatcanfattenyouup.

Ifyouarestuckinthe“carbsarefattening”mentality,letmesharetheresults

of an important study. National Institutes of Health researchers asked 19

overweightvolunteerstofollowarigorouslycontrolledlow-carbdietandalow-

fat diet at separate times—all the while under the watchful eyes of the NIH

MetabolicClinicalResearchUnit,wheretheylivedthroughouttheexperiment.

Bothdietshadpreciselythesamenumberofcalories;thedifferencewassimply

thatonewaslowinfatandtheotherwaslow-carb.Buttheresultswereclear.

Thelow-fatdiettrimmedawayroughlytwiceasmuchbodyfat,comparedwith

thelow-carbdiet.

Low-carb diets can cause weight loss over the short run, but there are far

healthierways toachievethat goalandto makeweightloss lastover thelong

run.

Low-CarbDietsCanWorsenCholesterolLevels

Weight loss lowers cholesterol levels. On average, each pound you lose lowers your

cholesterollevelabout1point(thatis,1mg/dlor0.3mmol/l),

somostweight-lossdietshave

a side benefit of improving your cholesterol test results. The exception is low-carbohydrate

diets.Theyaresohighinfatandcholesterolthattheyincreasecholesterollevelsforaboutone

ineverythreedieters,someofwhomhaveeventuallyexperiencedwildlyhighcholesterollevels

and serious heart disease symptoms.



 There is no good reason to begin any low-

carbohydrate,high-proteindiet.

WHATTOEXPECT

Everyonelosesweightathisorherownpace.Inourstudiesusinglow-fatvegan

diets, weight loss averages about 1 pound per week. Adding exercise can

increaseyourweightlossdependingonyourregimen.

Youmayfindthatyouloseweight,thenreachaplateauandstaytherefora

while. If that happens, see if there is something in your diet you can change,

such as eliminating hidden sources of oil or boosting your fiber intake, or

bringinginthelow-energy-densityfoodswediscussedabove.Ourbodiesseem

tohavedifferentplateausdependingonthefatcontentofourfoods.Thatisto

say, if you drop the fat content slightly, your weight will probably drop a bit,

then plateau. If you drop the fat content more, you’ll drop down to a new

plateau.

Thesamethingworkswithfiber.DoaQuickFiberCheck,andifyou’renot

up to 40 grams per day, try adding more beans, vegetables, fruits, and whole

grainstoyourdiet.You’llfindthatthecombinationofsteeringclearoffatsand

bringinginfiberhelpstrimawaythepounds.

TakeYourTime

If you have gradually gained weight over the years, let it come off gradually.

Don’tstarveyourselfinthehopeofinstantresults.Ifyouareonanoptimaldiet

andare physicallyactive,nature willtakeits course.Asthe weeksgo by, you

willnotonlybeslimmer,youwillalsobehealthier.Yourcholesterolandblood

pressurearelikelytofallalongwithyourbloodglucose.Asalways,stayinclose

touchwithyour doctorsoyourmedicationdoses canberevisedas youregain

yourhealth.

CHAPTER7

HowtoTestYourselfandTrackYour

Progress

In this chapter, we will look at the various tests that allow you to track your

progress.Thefirstone,glucosetesting,isparticularlyimportant,butpleaseread

throughthewholechapter.Itwillhelpyoustayontherightpath.Wewillstart

withbloodtestsandthenlookatotherkindsoftesting,includingweight,blood

pressure,andexaminationsoftheeyesandfeet.

GLUCOSETESTING

Monitoring your blood sugar is important for controlling diabetes. Glucose is

measured in milligrams per deciliter (mg/dl) in the United States and in

millimolesperliter(mmol/l)inmostoftherestoftheworld.

If you have type 1 diabetes or are using insulin for type 2 or gestational

diabetes,youshouldcheckyourglucoseatleastthreetimesadayoraccording

towhateverscheduleyourdoctorrecommends.Ifyouhavetype2diabetesand

are using oral medications, there is no optimal testing frequency. As a rule of

thumb,however,whenyourdiet,medications,exerciseroutine,orhealthstatus

changes,itisimportanttotestmorefrequently.Ifyourdoctorisnotyetaware

thatyouareabouttomakeachange,nowisthetimetosharethatinformation.

Youshouldalsodiscusswhattodoifyourbloodglucoseistoohighortoolow.

Asyoubeginahealthfuldiet,yournumbersarelikelytofallsignificantly.

Regular glucose testing is especially important if you are taking diabetes

medications,particularlyinsulinormedicationsthatcauseyourbodytorelease

insulin.Thereasonisthatthesearepowerfuldrugsthatactivelypushyourblood

sugardown.Andyouarenowstartingapowerfulnewdiet.Thecombinationof

thesetreatments—drugsanddiet(sometimesalongwithexercise)—mayendup

pushingyourbloodsugartoolow.

I know what you may be thinking: Impossible! If all you have ever heard

from your doctor is that your blood sugar is too high, it’s hard to imagine it

could fall too low. Well, it can. The combination of a powerful diet and the

diabetes medications you may already be on can be very strong. In fact, your

bloodglucosecan fallso lowthatyoustart toshakeandsweat(seebelow for

othersymptoms).Thisiscalledhypoglycemia.Inrarecases,peoplewhomakea

majordietchangeorembraceastrenuousexerciseprogramwithoutbackingoff

onmedicationsfindtheirbloodsugardropsdangerouslylow—solowthatthey

can lose consciousness. This is why it is essential that your doctor be made

aware of the changes you are making—so your medication dosages can be

alteredifyourbloodglucosetakesanosedive.

Dangeroushypoglycemiaisveryunlikelyifyouareonnomedications,and

itisalsounlikelyifyouarebeingtreatedwithonlymetformin(Glucophage)ora

thiazolidinedione, such as pioglitazone (Actos) or rosiglitazone (Avandia).

However,hypoglycemiaislikelytooccurifyoutakeanyofthefollowingdrugs.

• Insulin(injectedorpump)

• Glyburide (Micronase, Glynase, DiaBeta, or the combination drug

Glucovance)

• Glipizide(Glucotrol)

• Glimepiride(Amaryl)

• Nateglinide(Starlix)

• Repaglinide(Prandin)

This is just a short list of medications that may put you at risk. Ask your

doctorifthemedicationsyouaretakingmaycausehypoglycemia.

Although hypoglycemia is a sign that your body is regaining its insulin

sensitivity—which is of course a good thing—it is also a sign that your

medicines are now too strongandthat you need to speak with your physician

rightawayaboutadjustingyourmedicationregimen.Ifyourdoctorhasstopped

yourmedications,hypoglycemiaisveryunlikelytooccur.

Symptomsofhypoglycemiainclude:

• Shaking

• Sweating

• Hunger

• Anxiety

• Weakness

• Rapidheartbeat

• Dizzinessorlightheadedness

• Sleepinessorconfusion

• Difficultyspeaking

Ifyouexperiencethesesymptoms,checkyourbloodsugar.Ifitisbelow70

mg/dl (3.9 mmol/l) or whatever other benchmark value your doctor

recommends,youneedtoeatsomethingthatraisesyourbloodsugarquickly.If

you notice symptoms while driving, pull over to a safe spot. And if you are

unabletotestyourbloodsugarorareunsurewhetheritislow,assumethatitis

lowandhavesomethingtoeat.Glucosetabletsareagreatchoice.Theyaresold

atalldrugstores,andyouwillwanttokeeptheminyourpurseorbriefcaseand

in your glove compartment. If your blood sugar check shows you are

hypoglycemic,youshouldtake15gramsofglucose.Ifyouhavetypicalglucose

tabletswith4gramsofglucoseeach,youwillneedtotakefourtabletsatonce.

Herearesomeothergoodchoices.

• ½cup(4ounces)ofanyfruitjuice

• ½cup(4ounces)ofaregular(notdiet)softdrink

• 5or6piecesofhardcandy

• 1or2teaspoonsofsugar

After15minutes,checkyourglucoseagain.Ifitisstillbelow70mg/dl(3.9

mmol/l),have anotherserving,thencheckagain inanother 15minutes.If you

arewithinanhourofmealtime,goaheadandeat.Ifnot,haveasnack.Besureto

carryglucose tabletsor aquick-energyfood withyou foremergencies,weara

medicalidentificationbracelet,andbeespeciallyattentivetoyourglucoselevel

duringexercise,whichcancausebloodsugartodrop.

Hypoglycemiacanalsooccurwhileyouareasleep.Lookforthesesigns.

• Nightmaresorcryingout

• Findingthatyourpajamasorsheetsaredampfromperspiration

• Awakeningwithunusualtiredness,confusion,orirritability

Carl’sHypoglycemicEpisode

Carlhadbeentakingmetforminandglipizideforabout5years,andhismorningbloodglucose

valuesrangedbetween120and150mg/dl(6.7and8.3mmol/l).Hechangedhisdietwiththe

hope of coming off his medications, and in fact, very soon after he began this program, his

readingsbegan to drop. After about 2 weeks, they were often under 100 mg/dl(5.6 mmol/l).

Carlwasdelightedwithsuchclearevidencethatthechangeswereworking.

Abouta month into the diet,he had an unusual experience.One morning at about 10:00

a.m.,hefoundhimselffeelingunusuallyhungry.Healwayshadagoodappetite,butthiswas

somethingdifferent.Hefeltravenous.Overthenextseveralminutes,hestartedtotrembleand

brokeintoasweat.“Oh,yes,”hethoughttohimself.“Thisiswhattheytoldmemighthappen.”

Hecheckedhisbloodglucose,anditwas65mg/dl(3.6mmol/l),whichislowerthanitshould

be.Hehadsomeorangejuiceandanearlylunch.Hetelephonedhisdoctor,whoreducedhis

glipizide dosage. Over the next several weeks, the episodes repeated several times.

Eventually,hisdoctorstoppedtheglipizidealtogether.

Carl’s morning blood glucose readings stabilized at around 80 to 90 mg/dl (4.4 to 5.0

mmol/l). He never needed to go back on glipizide, and he never had another hypoglycemic

episode.

Iftheseoccur,youcancheckfornighttimehypoglycemia.Simplysetyour

alarmforabout2:00or3:00a.m.andcheckyourbloodsugarafewnightsina

row.Consultyourdoctortoseeifyouneedamedicationchange.

Hypoglycemiadoesnotmeanthereisanythingwrongwithyourdiet.Rather,

itmeansthatthemedicationregimenyouareonhasbecometoostrongforyou.

Thenextstepistocontactyourphysicianorothercaregiver,whowillprobably

reduce your medication dosages or eliminate one or more drugs. Get in touch

withyourdoctorassoonaspossible—thesamedaytheepisodeoccurs.Donot

put it off, because the hypoglycemic episodes are likely to recur until your

medicationsarereduced.

Totrackyourbloodsugar,usealogbookorasimplegridliketheonebelow.

BloodGlucose

DATE MEDICATIONREGIMEN EARLY BREAKFAST LUNCH DINNER LATE

/ / /

Note:Itisespeciallyhelpfultocheckyourbloodglucosebeforemeals.Markthesenumbersto

theleftoftheslashmarks.Markafter-mealvaluestotherightoftheslashmarks.

MAKINGSENSEOFGLUCOSE

Blood glucose values are a bit like the stock market: Although they generally

followatrend,theycanbouncearoundfromdaytoday.Certainsituationscan

triggeranunexpectedrise.Anysortofillnessorinfectioncanboostyourblood

glucose; even a minor upper respiratory illness or a scraped foot can cause a

significant jump in your numbers. Stress can, too, due to the action of stress-

relatedhormones.

Having some up-and-down swings in blood sugar is normal, but if your

glucoseremainshighdayafterday,yourriskofcomplicationsishigherthanit

would beif your glucose level werebetter controlled. The AmericanDiabetes

Associationrecommendsthatpeoplewithdiabetesusethefollowingguidelines

forbloodglucoselevels.

• Fastingorbeforemeals:80to130mg/dl(4.4to7.2mmol/l)

• Oneto2hoursafterameal:below180mg/dl(10.0mmol/l)

THEDAWNPHENOMENONANDTHESOMOGYIEFFECT

Youmayoccasionallybesurprisedtofindthatyourbloodglucoseishigherin

themorningthanitwaswhenyouwenttobedthenightbefore.Orperhapsyou

checkedyourglucoseintheearlymorningandthenwentbacktosleep,onlyto

findthatithadrisenwhileyouslept.Howisthispossible?

No,sugarplumsdancinginyourheadhadnothingtodowithit.Thefactis,

yourbodyconstantlymonitorsthe amountof glucosein yourbloodstream and

adjusts it from time to time. Glucose is vital to your body’s functioning—

especiallytotheworkingsofyourbrain—soyourbodyhasawayofincreasing

yourbloodglucosewhenitgetsabitlow.Intheearly-morninghours—typically

between 5:00 and 9:00 a.m.—hormones (growth hormone, cortisol, and

catecholamines)causeyourlivertoreleaseglucoseintothebloodstream.These

hormones can also interfere with insulin’s efforts to remove glucose from the

blood.This“dawnphenomenon”cannoticeablyraiseyourbloodsugar.

Asimilarreactioncanoccurwhenapersonusinglong-actinginsulinhasan

unusualbloodglucosedipinthemiddleofthenight.Let’ssay,forexample,that

youmissyourusuallate-nightsnack,andtheinsulinyouaretakingforcesyour

glucose level too low. Once again, your natural hormones will compensate,

raisingyourbloodsugar.ThisiscalledtheSomogyieffect.Itisdifferentfrom

thedawnphenomenoninthatitistriggeredbyanoverlylowbloodsugarlevel

occurringinthemiddleofthenight.

Althoughyourbodyhasasystemforcontrollingyourbloodsugar,itisabit

imprecise.Yourbloodsugarcanstillruntoolowortoohighdespiteyourbody’s

bestefforts,and youwill occasionallysee ahigh orlow levelthat youcannot

explain.

HEMOGLOBINA1C

As discussed in Chapter 1, the main test for assessing your progress is

hemoglobinA1C.YourA1Clevelshouldbecheckedevery6months,orevery3

months if your diet, medications, or general health is changing or if previous

valueshavebeentoohigh.IfyourA1Cishigh,yourdoctorwillbeconcerned,

andyoushouldbe,too.Ifitislow,youaredoingwell.Togiveyouaframeof

reference, the American Diabetes Association says that most people with

diabetesshouldkeeptheirA1Cbelow7percent.Alowertarget,say6.5percent,

makessense ifyoucangetthere withoutriskinghypoglycemia (thatis,ifyou

arenotonmedicationsthatarelikelytocausehypoglycemia).Ifyoudotendto

have frequent hypoglycemic episodes, your caregiver may recommend a less

stringenttarget,say8.0percent,inordertokeepyourbloodglucosefromfalling

toolow.

AtypicaloraldiabetesmedicationbringsA1Cdownbyanaverageofabout

1pointorabitless.TheeffectofagooddietonA1Cvariesdependingonhow

good your control is when you start, how well you follow the diet, and how

much excess weight you lose. Your result will also be affected by exercise,

genetics,andotherfactors.

Thebiggestdropswehaveseeninshort-termresearchstudiesarearound4

pointsinapproximately6months.TheseareseeninpeoplewhoseA1Cswere

high(say,9or10)tobeginwith.PeoplewhoseA1Csareinthe7to8rangeare

likelytohaveadropaveragingbetween1and2points.Peoplewhocontinueto

lose weight beyond this time could have an even greater drop, assuming they

werenotalreadyinthenormalrange.

The higher your A1C, the greater your risk of circulatory problems.

EvidencesuggeststhatkeepingA1Clowisparticularlyimportantforthehealth

ofyoureyesandkidneysandforpreventingnervesymptoms.

Fromyourheart’sstandpoint,a1-pointincreaseontheA1Cscale—from7

to8or8to9,forexample—bringsabouta20percentincreaseinyourriskof

heartproblemsoveraboutadecade.

Inotherwords,ifyouhada10percentrisk

ofhavingaheartattacksometimeinthenextdecade,a1-pointriseinyourA1C,

maintained over the whole decade, would boost your risk to 12 percent. A 2-

pointrisewouldmeana14percentrisk,andsoon.Whatthesenumberstellusis

thatA1Cisimportantand thatby allmeans,youwillwantto aimtogetyour

A1Cdown.However,A1Cisnotthesolekeytogoodhealth.Tostopdiabetes

fromattackingyourheartandbloodvessels,youwillalsowanttofocusonyour

blood pressure, cholesterol, and weight. Needless to say, your doctor can and

shouldtrackthesevalueswithyou.

CHOLESTEROL

Yourdoctorwillcheckyourcholesterolatregularintervals,atleastonceayear.

AsyouwillseeinChapter12,highlevelsofcholesterolinthebloodcandamage

yourheart,majorbloodvessels,andthedelicatebloodvesselsoftheeyesand

kidneys.Herearethenumberstoaimfor.

Totalcholesterol.Accordingtomostauthorities,totalcholesterolshouldbe

below200mg/dl(5.2mmol/l).Isuggestyouaimforaconsiderablylowergoal,

however. First of all, the average cholesterol level in the United States is

hoveringaround200mg/dl,andinacountrywhereheartattacksarethecauseof

deathforhalfthepopulation,youdonotwanttobeanywherenearaverage!In

largepopulationstudies,itisclearthattheloweryourcholesterol,theloweryour

risk of heart problems, until you reach a threshold of about 150 mg/dl (3.9

mmol/l). My suggestion is to use that as your goal rather than the more

permissive“official”figure.

Low-densitylipoprotein(LDL)cholesterol.LDLcholesterolisoftencalled

bad cholesterol because it raises your risk of heart problems and other blood

vesselcomplications.Accordingtomostauthorities,yourLDLshouldbebelow

100 mg/dl (2.6 mmol/l). Your risk of heart problems drops as LDL decreases,

untilyoureachalevelofapproximately40mg/dl(1.0mmol/l).

High-density lipoprotein (HDL) cholesterol. HDL cholesterol is often

called good cholesterol because it carries cholesterol out of the body. Some

evidencesuggeststhatthehigheryourHDLcholesterol,thebetter.Currentgoals

areto havean HDL levelabove 40mg/dl (1.0mmol/l)formenand above50

mg/dl(1.34mmol/l)forwomen.

Some doctors, however, interpret HDL in the context of your total

cholesterol concentration: In this case, a favorable HDL reading would be at

leastone-thirdofyourtotalcholesterol.Forexample,ifyourtotalcholesterolis

150,a healthyHDLwould be50 orabove.This isan importantconsideration

becausemanypeoplewhofollowhealthfuldietsdonothavemuchofanykind

ofcholesterol—LDL,HDL,oranythingelse.

RecentevidencehascalledtheimportanceofHDLintoquestion.Although

loweringLDLcholesteroldoesreduceyourriskofheartproblems,raisingHDL

doesnotseemtomakeanydifference.

Triglycerides. Triglycerides are tiny fat particles transported in the

bloodstream. Normal triglyceride concentration is less than 150 mg/dl (1.7

mmol/l).

SeeChapter12forinformationoncontrollingcholesterolandtriglycerides.

TRACKINGYOURBLOODPRESSURE

Maintaininghealthybloodpressureisextremelyimportant.Asyoucanimagine,

increased pressure inside your arteries can damage the arteries themselves, as

well as your heart, eyes, kidneys, and nerves. The longer your blood pressure

stayshigh,themoredamageitcando.

Problemscantravel intheotherdirection,too: Damagetothekidneyscan

leadtohighbloodpressure. Thereasonis thatyour kidneysplay animportant

role in regulating your blood pressure, and if they have been assaulted by

diabetes,theycanlosesomeoftheirabilitytodothis.

InChapter12,wewilllookathowdietaffectsbloodpressure.Fornow,here

areyourtargets.

Normalbloodpressureislessthan120/80millimetersofmercury(mmHg).

Ifyouhavehighbloodpressure,yourcaregiverwillworkwithyoutoreduceit

to below 140/90, and to below 130/80 if you can get there without serious

medicationsideeffects.Ifyouarepregnant,thetargetwillbe120–160/80–105,

aimingtoprotectbothyouandyourbaby.

It goes without saying that diet changes are key for controlling blood

pressureandcanoftenmakemedicationsunnecessary.Thesameplant-baseddiet

thathelpsyouloseweightandbringsdownyourbloodsugarwillalsohelpyou

controlyourbloodpressure.

Haveyourbloodpressurecheckedregularly.Ifitisnotwhereitshouldbe,

take another look at your diet and speak with your doctor about what, if any,

additionaltreatmentsyoumayneed.Ahealthfuldietandtheweightlossitbrings

canalsomeanthatyourcaregiverwillcutbackonbloodpressuremedicinesyou

maybeon,orstopthemaltogether.Butdon’tstopyourmedicinesonyourown.

CHECKINGYOURKIDNEYHEALTH

Becauseyourkidneyscaneasilybeaffectedbydiabetes,yourdoctorwillcheck

yourkidneyhealthwithasimpleurinetestatleastonceayear.Thegoalistosee

whetheryour kidneysare losingprotein, specificallya proteinmolecule called

albumin.Albuminitselfisnotespeciallyimportant.Whatisimportantisthatifit

shows up in your urine, it is a sign that your kidneys have been affected by

diabetes and are not holdingonto albumin as they should. Albumin losses of

greaterthan30milligramsover24hoursareconsideredabnormal.Yourdoctor

willalsocheckyourbloodforcreatinineandestimateyourglomerularfiltration

rateandwillinterprettheresultsofthesetestsforyou.Formoreonfactorsthat

influencekidneyhealth,seeChapter13.

OTHERROUTINELABORATORYTESTS

Your doctorwill run other tests totrack your progress. The followingare two

verycommonones.

Completebloodcount(CBC).Thistestshowsthestateofyourbloodcells.

Manypeoplewithdiabetesdevelopanemia,meaningtheyhavefewerredblood

cellsthantheyshould.Acompletebloodcountletsyourdoctoreasilycheckthis

and many other measures. If your blood count is low, your doctor will

investigate the reasons for it, which could include kidney disease, iron

deficiency,useofcertainmedications,abnormalbleeding,orotherfactors.

Chemistrypanel.Aroutinechemistrypanelisalsoknownbyseveralother

names.Itassessesyouroverallhealth,withaspecialfocusonthestatusofyour

kidneys and liver and lets doctors check for potential adverse effects from

medications.

Thereisnoreasontodespairifanyofyourlaboratoryvaluesarenotwhere

they should be, but it is definitely a reason to take action. You will want to

optimizeyourdietandworkwith yourdoctorto plota coursefortrackingthe

effectivenessofyouroverallhealthregimen.

TAKINGSTOCKOFYOURDIET

Iwould like toshift gearsnow andlookat yourdiet andoverall health.First,

let’stakeaminutetomakesurethatyourdietisgoingaccordingtoplan.

• Areyourfoodsvegan?Youknowyouaredoingwelliftherearenofoodsof

animaloriginonyourplate,notevenlittlebitsoffish,fat-freemilk,oregg

white—nothing. If you have done this right, there is no animal fat, no

cholesterol,andnoanimalproteininyourdiet.Yourmenuisbuiltfromplant

foods,anditisrichinfiberandallthehealthynutrientstheplantkingdom

bringsyou. Ifyou needa refresheron whyyou aredoing this,please take

anotherlookatChapter4.

• Areyourmealsalllowinfat?Itisimportanttoreallykeepfatsandoilstoan

absoluteminimum.Becarefulwithnutsandnutproducts.

• Are your foods low GI? The main problem foods are sugar, corn syrup (a

common sweetener in processed foods), white and whole wheat breads

(favor rye and pumpernickel), and baking potatoes (choose sweet potatoes

andyams).

QUICKFIBERCHECK

OnewaytohelpgaugehowyouaredoingiswiththeQuickFiberCheck.Itisa

handylittletool,andIsuggestthatyoudooneaboutonceaweekasyoubegin

thisnewapproachtoeating.Scoringissimpleandtakesonlyaminuteortwoto

learn. Soon, estimating the fiber content of virtually everything in the

supermarketwillbeasnap.Youwillalsoseeifyouaregettingenoughfiberin

your daily menu. It doesnot take long, and it will help you see if you areon

track.

First,takeaminutetojotdowneverythingyouateordrankfor1fulldayon

aformsimilartotheexamplebelow.Iwillexplainbelowhowtofillinthefiber

column.

Then,nexttoeachfood,noteitsfiberscore,usingthefollowingguide.

Beans: For each serving of beans or lentils (one serving = ½ cup) or any

food that includes about this amount of beans or lentils as an ingredient, give

yourselfa7.Onecupofsoymilkor½cupoftofu(bothmadefromsoybeans)

ratesa3.

Vegetables: For each serving of vegetables (one serving = 1 cup), give

yourselfa4.Anexceptionislettuce,forwhich1cupscoresa2.Apotatowith

skinscoresa4;withouttheskin,a2.

Fruit:Foreachmediumpieceoffruit(e.g.,anapple,orange,orbanana;1

cupapplesauce;abananasmoothie),marka3.For1cupofjuice,marka1.

Grains: For each piece of white bread, bagel, or equivalent, score a 1.

Wholegrainbreadsscorea2,asdoes 1cupof cookedpasta.One cupofrice

scoresa1forwhiteanda3forbrown.Onecupofcookedoatmealscoresa4.

Scorea3fortypicalready-to-eatcereals,a1forhighlyprocessedandcolored

cereals,andan8forbran.

Soda,water:Scorea0.

InterpretingYourScore

Totalyourfiberscoreandlet’sseehowyouaredoing.

Lessthan20:Youneedmorefiberinyourdiet.Asitis,yourappetitewill

be hard to control, and you may have occasional constipation. Boosting fiber

willhelptameyourappetiteandcutyourriskofmanyhealthproblems.

20–39:You aredoing betterthanmost peoplein Western countries,but as

you bring more fiber into your diet, you will find that it makes foods more

satisfyingandcutsyourcalorieintakeabit.

40ormore:Congratulations!Youhaveplentyofhealthyfiberinyourdietto

controlyourappetiteandhelpkeepyouhealthy.Fiberalsoreducesyourriskof

developingcancer,heartdisease,diabetes,anddigestiveproblems.

CHECKINGYOURWEIGHT

Of all the things that predict success in dealing with diabetes, leaving behind

excessweightisamongthemostimportant.ThestrategyoutlinedinChapter6is

ahighlyeffectivewaytogoaboutit.

Herearesometipsfortrackingyourprogress.

• First,trackyourweight.Somepeoplewhohavebeenoverweightforalong

time have not gone near a scale in years. If that sounds like you, give it

another try. It is essential to know if you are losing. If you are not losing

weight,itistimetochangecourse.Usually,thatmeanstuningupyourdiet.

Weightlossissometimesdifficult,andgenetictendenciesdoplayarole,but

yourdietisonethingyoureallycancontrol.

• Usethesamescaleeachtimeyouweighyourself.Differentscalescangive

dramaticallydifferentreadings.

• Checkyourweightatthesametimeofdayeachtime.Withfoodandwater

intake, you can easily gain and lose a few pounds in the course of a day.

Usually,youwillbeheavierintheevening.

• In gauging the success of your weight loss, about 1 pound per week is a

healthful goal. It is about what you can expect if you follow the diet

presentedinthisbookwithoutdoingparticularlyvigorousexercise.Slower

weightlossisalsofineaslongasyouaremovingintherightdirection.

• Do notrelyon exercise alone forweight loss. A healthful dietchange can

easilytrim300to400caloriesadayoffyourdailymenu,butburningthat

manycaloriesthroughexercisemeanswalkingorrunning3or4milesaday.

Exerciseisimportant,butitcannotbegintotaketheplaceofdietchanges.

CHECKINGYOUREYES

Atleastonceayear,youshouldhaveaneyeexaminationbyanophthalmologist

to check for any sign of retinopathy. These changes cannot be detected by an

ordinary eye examination with a doctor’s ophthalmoscope or during an

optometricexamination foreyeglasses.Also besure tosee aneyespecialistif

youhavehadanychangesinyourvision.

Ifyousmoke,tellyoureyedoctor.Yes,youwillgetalecture,anditistime

to listen up if you are still smoking. See Chapter 13 for information on the

effectsofnutritiononeyehealth.

CHECKINGYOURFEET

Footproblemsarecommonindiabetes.Ifyour bloodglucose hasbeen poorly

controlled, you are at risk of developing neuropathy—nerve damage—which

meansyoumaynotbeawareofsmallinjuriestoyourfeet.Woundhealingmay

beslowedaswell.Smallinjuriescangraduallyworsenandbecomeinfected.

Forthisreason,younotonlywanttogetyourdietintoshapebyfollowing

theguidelinesinthisbook,youalsowanttohaveyourdoctorcheckyourfeetat

leastonceayear.Theexaminationwillincludeacheckforsensationusingathin

plasticthread,acheckofyourvibratorysensewithatuningfork,andathorough

check for any signs of damage to your skin. Take the advice of Mary Ellen

Wolfe, RN, a nurse working with George Washington University, who

recommendsthatyoutakeoffyourshoesandsocksateverydoctor’svisittobe

sureyourdoctordoesnotforgettoexamineyourfeet.

STAYINGHEALTHY

Nomatter howhealthyyou get,youshould stillkeepaneyeon yourglucose,

A1C,andcholesterol;bloodpressure;weight;eyes;andfeet.ButIhopeasyou

tuneupyour dietandlifestyle,that it’sallyouwill bedoing—justconfirming

thatallisjustasitshouldbe.

CHAPTER8

APerfectDietinanImperfectWorld

Itisnotalwayseasytofollowaperfectdietinanimperfectworld.Therewillbe

times when those you depend on—restaurants, airlines, co-workers, and even

familymembers—havelittleunderstandingoforinterestinhealthyfoods.This

chapter is dedicated to these situations. I will cover dining out, travel, social

situations,workingwith yourdoctor,and dealingwithfamily members.When

lifethrowsyouacurve-ball,Iwillshowyouhowtostepuptotheplateandstay

inthegame.

DININGOUT

Diningoutispartoflife,andyououghttobeabletoenjoyanightonthetown

with friends or loved ones without missing a beat on your new healthy diet.

Luckily,manyrestaurantmenusofferplentyofhealthyselections.Unfortunately,

othersarelimited.Oftenthekeytosuccessliesinwhereyougoandwhatyou

orderwhenyougetthere.Hereareafewtips.

First, think international. In Mediterranean countries, Asia, Africa, and

Latin America, the traditional dietary staples are grains, vegetables, legumes,

andfruits.Notsurprisingly,alloftheseregionshavehistoricallyhadmuchlower

rates of diabetes than North America and Western Europe. When you choose

fromthebestofwhatthesecuisineshavetooffer,dinneroutcanbebothhealthy

anddelicious.

Italian restaurants are everywhere, and they would love to serve you

spaghetti with a marinara or arrabbiata sauce, minestrone, pasta e fagiole (a

traditionalsoupmadewithpastaandbeans),healthysalads,chunkyvegetable-

and-tomato pizza,grilled asparagus, and steamedspinach. Because their foods

areusuallymadetoorder,itisasnapforchefstominimizeoil,leaveoffcheese,

servesaucesontheside,andsoon.

Mexican restaurants are ubiquitous in North America and serve bean or

vegetableburritos,veggiefajitas,rice,andsalads.Mosthavestoppedusinglard

tomaketheirbeans,andallarehappytoskipthecheese.Topfoodswithsalsaif

youlike.

LatinAmericancuisinecomesinotherwonderfulvarieties,too.Cubanand

Brazilian restaurants offer black bean dishes, rice, plantains, salads, salsa, and

otherhealthfulfare.

Chinese restaurants will get you started with vegetable spring rolls or

vegetablepotstickers andvarioushealthy soups.Favorthe steamed,notfried,

items. Skip the meat dishes and get right to the long list of savory vegetable

maindishes made withtofu (alsoknown asbean curd), greenbeans, broccoli,

spinach,andotherhealthfulingredients.ThedangerinChineserestaurants,asin

mosteatingestablishments,isoverexuberancewiththeuseofoil.Askthatyour

foodbepreparedwithaslittleoilaspossibleandhaveyourmaindishalongwith

plentyofrice,preferablybrownrice.

Japanese restaurants are among the very best choices when it comes to

healthful dining. Sushi chefs are delighted to transform carrots, cucumbers,

radishes,sweetpotatoes,andothersimpleingredientsintoedibledelights.Have

themalongwithmisosoup,salads,seaweed,andvariousappetizers.

Thai and Vietnamese restaurants serve many meatless dishes that include

rice,softnoodles,vegetables,andtofualongwithwonderfulsauces.

Indian restaurants are mixed. While vegetarian diets are traditional and

highly respected among many Indians, the use of oil and dairy products often

puts them in the no-go zone. Your best choices are soups, rice dishes, and

vegetablecurriespreparedwithminimaloil.

Ethiopianrestaurants arecommon in majorcities. Becausesome religious

groups in Ethiopia follow vegan diets during certain days of the week and

certaintimesoftheyear,therestaurantsservemanydishesmadewithchickpeas,

split peas, lentils, green beans, peppers, and delightful spices. They will be

happytoserveyoualltheirveganitemsonalargeplatterforawonderfuldinner.

Americanrestaurants, family restaurants,and even steakhouseshave salad

barsandoffervegetableplates.Manyservepastadishesevenwhentheyarenot

onthemenu.

Second,askforwhatyouwant.Ifwhatyouarelookingforisnotonthe

menu, do not be afraid to ask. Most restaurateurs will gladly alter their main

offeringstoaccommodateaspecialrequest.Ifyouwouldlikecheeseandbacon

bitsleftoffyoursalad,ifyouwouldlikeavegetableplate,orifyouwouldlike

yourpastatopped withtomatosauceinstead ofmeatsauce,by allmeans,ask.

You will not only get a better meal, you will also help the restaurant

managementunderstandhowtobetterservepatronslikeyou.

AsInotedabove,restaurantkitchensoftenoverdoitwithoils,soaskyour

serverhowfoodsarepreparedandrequestthatyourmealbemadewithaslittle

oilaspossible.InItalianrestaurants,spinachandbroccoliareoftensautéed,but

theycanalsobesteamed.ThesamegoesformostAsianvegetabledishes.

Saucesandcondimentscanalwaysbeservedontheside.Thisgoesforpasta

sauces, salad dressings, brown sauces used in Asian cuisine, spreads used on

sandwiches,andsimilaritems.

Askforwhatyouwant.Youwillbegladyoudid.

ABreakfastTrick

mostrestaurantswillgladlyserveahealthfulbowlofoatmealforbreakfastand

will top it with strawberries, blueberries, or cinnamon. But once in a while,

you’llfindpreciouslittleateateriesthatarebusyservingbaconandeggs.Here’s

atrick:

Ask the server to have the cook throw some tomatoes, spinach, and

mushroomson thegrill. Maybesome asparagus,too. Chefsare accustomedto

stuffingthemintoomelets;now,you’rejusthavingthemwithouttheeggs!With

asideofryetoast(nobutter,ofcourse),you’reset.

FastFood

Fastfoodisrarelyatopchoicewhenthepriorityishealthyeating.Ontheother

hand, these chains are big businesses that understand the growing demand for

healthyfood choices.More andmoreoften, youfind offerings ontheir menus

thatfitintoahealthydiet.

TacoBell’sbeanburrito—ifyouholdthecheese—isentirelyvegan.Ifyou

like,addtomatoes,lettuce,orjalapeñochilepeppers.

BurgerKingoffersaveggieburgerthatis muchlower infatthanits other

sandwichesandwillalsogladlysellyouaVeggieWhopperwithallthetoppings

butwithouttheburger.Submarinesandwichshopswillgladlyleaveoffthemeat

and cheese and pile on the lettuce, tomato, cucumbers, spinach, and peppers,

plus a dash of red wine vinegar. And they will even toast it for you. Denny’s

offers a veggie burger, and most family restaurants serve plenty of side

vegetablesthattogethermakeagoodvegetableplate.

Some fast-food restaurants offer salad bars. With chickpeas, three-bean

salad,cherrytomatoes,andchoppedvegetables,asaladbecomesaheartymeal.

Inthatvein,oneofthebest waystoget healthyfoodfast istostop atany

largesupermarketandpatronizeitssaladbar.Awealthofgreatchoicesisrightat

yourfingertips.

NANCY’SANDVANCE’SEXPERIENCES

Nancy often dined with friends who liked good food and good restaurants. I

encouragedhertochooseethniccuisine—Chinese,Japanese,Italian,orThai,for

example.Unfortunately,thatwasnotwhatmostofherfriendshadinmind,and

theyfeltuncomfortableknowingshewouldnoteatunhealthythings.

Whenshe headedout tojoin friendsat arestaurant thatmight notbe very

accommodating,sheoftenhadasnackinadvancesoshewouldnotbestarving

whenshegotthere.Whenshewenttoopenhousesduringthewinterholidays,

sheoftenvolunteeredtobringafruitandvegetabletray.

Ona vacation toIceland, shepacked granolabars and individualsoy milk

packagesinherluggage,tosupplementthelocalfood,andgotbyjustfine.

“Iamtemptedsometimes,especiallywhenIamstressedorovertired.Italk

myselfoutofit,”shesaid.

Shefoundithelpfultokeepthingsinperspective.“Youhavetodecidewhat

yourprioritiesare,”sheexplained.“Ididn’twanttosufferfromtheeffectsofthe

disease.Iwantedtostoptheprogression.Ididn’teventhinkaboutreversingit.

AndnowI’mawalkingadvertisementfortheprogram.Peoplekeepaskingme

howI’vedoneit.I’vedescribeditindetailtoprobably40people.”

When Vance dined out, he looked for veggie burgers, fresh steamed

vegetables, and pasta without cheese and oils. His challenge was sports

stadiums.“Ilovegoingtobaseballandfootballgames,wherefrenchfries,hot

dogs,andsoftdrinksareaboutallthat’soffered.Itwouldbegreattobeableto

bringinhealthyfoodorevenjustsomecarrotsticksandabottleofwater,but

usuallytheydon’tallowanyfoodtobebroughtin.SoatfirstIstucktopretzels,

popcorn,andCrystalLight.AtagameinSeattle,Ismelledthefishandfries,and

itwashardtoresist,”hesaid.

VeggiehotdogsandburgerscametoVance’srescue.Althoughtheyarenot

necessarilytheultimatediningexperience,theyareamajorimprovementonthe

foods they replace, and more and more stadiums, movie theaters, and other

venuesarestartingtosellthem.

TRAVEL

Travel presents challenges no matterwhatkind of diet you follow. Here are a

fewwaystohelpkeepyourneweatingplanontrack.

Choose restaurants wisely. As you have seen, there are usually plenty of

vegan choices at nonvegan restaurants, particularly those that feature

internationalcuisine.Evensomefast-foodplacescanrisetotheoccasion.

Youmightgoonlinetocheckoutveganandvegetarianrestaurantsincities

you are planning to visit. A Web site called Happy Cow’s Vegetarian guide

(happycow.net) lists them by location, but call before you go; restaurants are

forever starting up and shutting down. There’s no reason to limit yourself to

these restaurants, though; almost any eating establishment should be able to

accommodateyou.

Plan before you fly. When you are booking an international flight (or

generallyupto48hoursbeforeyourflight),requestaveganmeal.Youwillgeta

healthymealandwilloftenbeservedfirst.

On domestic flights, most meal service has gone by the wayside, so you

mightpickupsomeeasy-to-packsnacksatahealthfoodstoreorsupermarket.

Vegan deli slices are great sandwich fillers and resist spoiling. A pack of

hummuswithpitabread,afewpiecesoffreshfruit,somebabycarrots,instant

soup cups(flight attendants willgladly provide hotwater),or a smallpop-top

canofchickpeascanbelifesavers.

SOCIALEVENTS

It can be tough to stick to the plan at parties, even when you know you will

regretaslipinthemorning.Ifyouarriveatapartyunprepared,theremaywell

benothing availablethat youcan eat.With abit ofplanning, though,you can

celebratewithoutleavingthehealthypathyouareon.Herearesomeideas.

Offertobringahealthydish.Let’ssayyouhavebeenaskedtothehomeof

somefriendsfordinner,andyouhavenoideawhattheywillserve.Hereiswhat

Isuggest:Whenyougettheinvitationorassoonthereafteraspossible,callyour

hoststoletthemknowthatyouhavechangedyourdietandthatyoudonotwant

toputthemtoanytrouble.Saythatyouwouldliketobringsomething,suchasa

low-fat hummus dip or an exotic fruit salad. I can almost guarantee that your

hostswillsaythereisnoneedtoworryandyouneednotbringanythingbecause

therewillbe plentyto eat. Now, regardless ofwhat they werereally thinking,

youhavealertedthemtoyourneedswithoutimposingintheslightest.

If you are reluctant to let your hosts know, do not be. They will be much

moreembarrassed iftheyfind outafterthe factthatthey serveda dinnerwith

nothingyouwantedtoeat.Besides,youareverylikelytofindthatotherguests

—andevenyourhosts—aremakingsimilardietchanges.

Bringahealthygift.Insteadoftheusualbottleofwine,whynotarrivewith

ahealthfulfoodgift?Afruitbasket,aloafofartisanpumpernickelbread,ora

healthy party dip (you can find all of these at health food stores) will delight

yourhostsandensurethatyouhavesomethingtoeat.

Avoid arriving hungry. If you arrive ravenous, you will be drawn to the

plattersofunhealthfulfoods.Ifyoueatsomethingbeforeyouarrive,youwillbe

fine.

Carryaplate.Partyguestswithnothingintheirhandsareinvitingothersto

offer them something. Make yourself a plate with a few crudités or a bit of

bread,andnoonewillbeinclinedtoofferyoufoodsyoudonotwanttoeat.

ATTHEDOCTOR’SOFFICE

Medicalcareisapartnership;youandyourdoctorneedtoworktogethertobest

meet your needs. This is true at any time, but especially when you are in the

process of changing your diet. The fact is, your diabetes will probably be

improving,andyouwillneedtoratchetdownyourmedications.

Some doctors are not easy to reach, and even if you have your doctor’s

attention,thatdoesnotmeanheorshewantstoengageinaconversationabout

nutrition. Some physicians show little interest in the topic, while others have

franklyoutdatedoruntestedideasaboutit.

Isuggestyoulendacopyofthisbooktoyourphysicianwithastickynote

flaggingChapter14. It was written fordoctorsand shows them how they can

besthelpyou.

You can help by holding up your end of the partnership. That means

following your doctor’s advice (provided it is sound and you agree with it),

letting him or her know how you are doing, calling promptly if your blood

glucose drops below 70 mg/dl (3.9 mmol/l) or whatever other criterion is set,

and taking a vitamin B

 supplement so he or she will not worry about your

developinganysortofdeficiency.Thetruthis,yournutritionismuchbetterona

vegandietthanonanomnivorousdiet,butaknowledgeabledoctorwillwantto

besureyouaregettingyourB

.Asupplementwilleasilytakecareofthat.

In the vast majority of cases, doctors are delighted when their patients

improve their diets. They are all the more delighted when they see the

improvementsonthescaleandinlaboratoryresults.

Oneofourresearchvolunteersthoughthisdoctorwouldbeskepticalabout

hisplans.Theytalkedaboutlittleasidefrombloodtestsandprescriptionsduring

hisappointments. To hissurprise,however, whenthe doctorfoundouthewas

starting a vegan diet, she was delighted. “That will probably help you a great

deal,”shesaid.Andindeed,itdid.Within6months,helost30pounds,wasable

tostoponeofhistwodiabetesmedications,andwascontinuingtoimproveweek

byweek.Hisdoctorhadnoformaleducationinnutrition,butsheknewsuccess

whenshesawit.Shenowrecommendsthesamediettootherdiabetespatients.

LOVEDONESWHOHELPANDHURT

Sometimesourfriendsandfamilymembershelpusstayonahealthypath.When

we are not enthusiastic about exercising, they encourage us by going with us.

When we are tempted by some less-than-healthful food, they shore up our

resolve.

Improvingourdietsislikequittingsmokingorbreakinganyotherhabit:We

needour family’s support.But sometimes,intentionally orunintentionally,our

lovedonesarenotsohelpful.Theymaynotbeawareoftherisksofabaddiet,

orperhapsthey arealltooaware andarestrugglingwith unhealthfulhabitsof

theirown.Theymayeventrytosabotageyoureffortstobreakbadhabits.

Iftheproblemisthatyourlovedonessimplydonothavemuchinformation

abouthealthfuldiets,lendthemthisbook.Iftheyarenoteagerreaders,trythis

littletrick:Putastickynoteorbookmarkatanypageyouthinktheywouldfind

of special interest. They will be drawn to that section, and once they start

reading,theywillprobablycontinue.

If family members tease you about your eating habits, remind them how

important your health is to you. Explain that it is tough for you to have

unhealthfulfoodsaroundand thatyou reallyneed theirhelp. Ideally, they will

joinyouinyournew,healthywayofeating.Iftheyjustwillnotchange,thenat

aminimum,theymustkeeptheirfoodseparateandnotteaseortemptyouwith

unhealthyitems.

GOODFOODFORTHEWHOLEFAMILY

Ifyouarepreparingmealsforyourfamilyandtheyarebalkingatnewfoods,do

not despair. It is natural to be cautious about anything new. Present healthful

foods without pushing them andrecognizethat it often takes a couple of tries

beforeanewitemreallycatcheson.

I suggest that you not fix healthy meals for yourself and less-than-healthy

meals for your spouse or children. Some people do this, figuring they cannot

change others’ bad habits. But remember this: Not only will introducing

healthful foods to your family bring you some very important allies, it will

benefityourlovedonesaswellasyou.

Theverybestsituationiswhenthewholefamilydecidestochangetogether.

Thereisnohealthreasonforanyonetoeatanimal-derivedfoods,fattyfoods,or

sugaryfoods.Yes,thesefoodsareeverywhereinmodernsocieties,buttheyare

theprincipalreasonfortheepidemicsofoverweight,heartdisease,cancer,and

otherhealthproblemsinNorthAmericaandmuchoftherestoftheworld.When

thewholefamilymakesthesamedietchange,theyallgetthesameadvantage.

Onegoodwaytobreakthroughresistanceistoaskyourfamilymembersto

tryashort-termdietchangewithyouasanexperiment.Saythatyou’dliketotry

newand healthy waysof eatingfor just3 weeks, andyou wouldlike themto

joinyou.Mostpeoplewilltryanythingforashortperiod.Bythetime3weeks

havepassed,theywillhavesortedoutthenewfoodstheylikeandwillbeready

formore.

Whenintroducinghealthfulfoodstochildren,itisgenerallybesttostickto

simple,familiaritems.Somechildrenmaynotyetcareforexoticvegetables,but

they will easily gravitate to fruit of all kinds, as well as corn, green beans,

carrots, peas, and other simple foods. Avoid wrangling with a child who is

reluctant to try a new food. Sometimesaltering the form of the food makes a

huge difference. A child who does not care for the texture of cooked spinach

maylikefreshspinachaspartofasalad.Steamedbroccoliandcauliflowermay

beintimidating,buttheymaybeperfectlyacceptablewhenchoppedandadded

toasouporstew.Kidsmaynotgoforlentilloaf,buttheyloveveggieburgers

andhotdogsandsandwichesmadewithvegetariandelislices.

Italwayshelpstopresentchoices.Wouldyourchildrenpreferbakedbeans

or lentil soup? Would they prefer their veggie burgers cut into halves or

quarters?Theideaistogivekidsasenseofcontrolwhileallthepossibilitiesare

goodones.

Insomefamilies,foodisasymbolofaffection.Parentsstufftheirchildren

with cookies and gooey desserts, as if love could be measured in calories.

Whateverthemotivation,noneofthisdoesyouonebitofgood.Findotherways

toexpressaffection.Abook,awalk,atriptothemovies—thereisnoshortageof

meaningfulgifts.

HEALTHFULFOODSINANUNHEALTHYWORLD

Avisitorfromanotherplanetmightwellconcludethatmoderncivilizationhas

no perceptible interest in healthful diets. Fast-food restaurants—and regular

restaurants—carrylotsoffatty,cholesterol-ladenmealsand farfewerhealthful

choices. Television commercials push endless less-than-healthful snacks.

Conveniencestoresandsnackmachinesofferlotsofwhatyoudonotwantand

preciouslittleofwhatyoudowant.Sometimes,youmayfeellikeapersonwho

istryingtoquitsmokingbutistrappedinabarwherecigarettesarefree.

Inlargepart,youwouldberight,buttruly,therearealsoplentyofhealthful

options. For every convenience store selling unhealthy food, there is a

supermarket with an ever-expanding range of great food products. For every

restaurantthatrefusestoserveanythinghealth-consciouseaterswouldlookfor,

there are a dozen that offer good choices. The range of health-oriented

cookbooksistrulyenormous,anditisnoweasierthanevertofollowahealthful

diet.Friendsandfamilymembers—eventhosewhodonotfollowhealthydiets

themselves—allknowthatwhatyouaredoingisworthsupporting.

CHAPTER9

Troubleshooting

Howareyoudoingwithyournewwayofeating?Areyoureachingyourweight-

loss goals? Are your glucose and A1C coming down? Is your cholesterol

improving?

Ifyouarehavinganysortoftrouble,thischapterwillguideyouthroughthe

mostcommonproblemspots.

NOTLOSINGWEIGHT

People who begin low-fat, vegan diets typically lose weight easily. In our

researchstudies,theaveragerateisabout1poundperweek.Somepeoplelose

morequickly,othersabitmoreslowly,butapoundaweekisagoodpace.Ifyou

think about what this means over a year’s time, the result is impressive,

particularly since you are free of the yo-yo syndrome that comes with diets

based on calorie restrictions. Because this is not a short-term, starve-yourself-

thin diet, it does not cause hunger, so there is no rebound bingeing. Gradual,

healthyweightlossiswhatyoucanexpect.Sometimeslosingweightcanbea

bitlikefollowingthestockmarket.Therearefluctuationsupanddown,butthe

trendshouldbeclear.Ifyouarenotlosingweight,itistimetotakeaction.Here

arethestepstotake.

Getbacktothebasics.BesureyouarefollowingtheguidelinesinChapter

4andgivingit100percent.Thatmeansnoanimalproductsinyourdietatall.If

yourdietincludesfishor cheese,for example,yourweight-losseffortswill be

hampered.

Checkforhiddenoils.Packagedfoodsshouldincludenomorethan3grams

offatperserving.Ifyoufrequentlyeatatrestaurants,trytoassesstowhatextent

they are packing oils into their meals. If you are unsure (or your server is

unsure), ask for foods to be steamed rather than fried or sautéed and that any

saucesordressingsbeservedontheside.SeeChapter8.

DoaQuickFiberCheck.Ifyoucheckyourfiberintakeandfindthatyou

are eating less than 40 grams of fiber per day, you’ll want to bring in more

beans,vegetables,andfruits.

Ifyourdietisvegan,lowinfat,andhighinfiber,itisveryhardnottolose

weight.Evenso,hereareafewthingstoconsider.

Simplify.Itpaystochoosesimplefoodsratherthanprocessedfoodproducts.

The fewer ingredients, the better—one is ideal. Beans, broccoli, carrots, or

brownrice,forexample,donotneedaningredientslist,becausewhatyouseeis

exactlywhatyouget.Youknowthatnoonehasaddedanyoilorprocessedaway

anyfiber.

Addmoreraw foods. Somepeople have had remarkableweightloss as a

resultofincreasingtheirintakeofrawfoods.Choppedvegetables,salads,fresh

fruit—theseareallrichinfiber,withnoaddedfatandlowGIs.

Don’tGetSidetrackedbyRationalizations

Sometimes people who are not losing weight blame genetics,lack of exercise, or something

elsefortheirproblem.Geneticsandexercisedoplayroles,ofcourse.Butifyouarenotlosing

weight,theproblemisnearlyalwaysdietary.

Once,enroutefromWashingtontoLondon,Iwasbusilytypingawayonmylaptop,writing

anarticleaboutdietchangesforweightloss.Thepassengernexttomehappenedtoseewhat

Iwas typingandtookan interestinthe topic.Hehadbeen overweightforseveral yearsand

wantedtoseewhatImightsuggest.Iexplainedourresearchfindingsabouthowdietchanges

couldcauselastingweightloss.Ipointedoutthatthekeyseemedtobechangingthetypesof

foods we eat. I launched into a discussion of the benefits of vegetables, fruits, beans, and

wholegrainsandthewonderfulmealstheycanbecome.

“That’s interesting,” he said, “but I think I just need to exercise more. That’s my real

problem.I used toexercise a lot,but lately, I’ve been so busy.”He brushed aside the whole

topicoffood.

Afewminuteslater, theflightattendantcamebywiththemealservice.Sheservedhima

ham-and-cheesesandwich,abagofchips,andasoftdrink,whichheshoveledintohismouth

withoutaword.Isuspecthedidnotrealizethatitwouldtakeaverylongsessionatthegymto

burnawaythoseunnecessarycalories.Theairlinealsoservedvegetarianmeals,whichwould

havebeenamuchbetterchoice.

Shortly thereafter, I was talking to a patient with Stanley Talpers, MD, an internist on the

faculty of the George Washington University School of Medicine in Washington, D.C. The

patientsaidhehadn’tbeenlosingweight,andhefiguredthathejustneededtowalkmore.Dr.

Talpers encouraged him to get his diet in order first because, he said, “to lose a pound by

walking, you’d have to walk to Baltimore.” It is true. Exercise is beneficial, and I strongly

recommend it. But a lack of exercise is not the primary reason for weight problems, and

exercisecannevertaketheplaceofahealthfuldiet.

BLOODGLUCOSENOTCOMINGUNDERCONTROLQUICKLY

ENOUGH

TheprimarywayoftrackingyourglucosecontroliswithhemoglobinA1C.As

youknow,theAmericanDiabetesAssociation’sgoalistohaveyourA1Cunder

7.0 percent. If you are not making good progress toward your goal, here are

somepointstoconsider.

Get back to the basics (again). If you are overweight, weight loss is the

strongestpredictorofahealthydropinA1C.Tojump-startweightloss,takea

look at the tips above and in Chapter 6. Whether you are overweight or not,

thosesamepointsarealsothekeystobringingyourglucoseundercontrol.

If your diet is vegan, it has no animal fat in it, of course. And if you are

setting aside vegetable oils, it has very little of any kind of fat. With these

healthychanges,youcanjustimaginethoselittlebitsoffatinsideyourmuscle

cellsstartingtoshrivelup.AsyousawinChapter2,thesearethebitsoffatthat

appeartobethecauseofinsulinresistance.

Embrace healthy carbohydrates. Many people tie one arm behind their

backsbyavoidingstarchyfoods.Theyimaginethatbeans,lentils,pasta,sweet

potatoes,oryamswillpushtheirbloodglucoseupward.And,ofcourse,ifyou

checkyourbloodglucoseafterjustaboutanymeal,itwillbehigherthanitwas

before.However,don’tletthisturnyouagainststarchyfoodsandbacktoward

fattyorhigh-proteinfoods.Hereiswhy.

Thefatinfishandchickenwilltendtoarrestyourweightloss.Itwillalso

tendtoaggravateyourinsulinresistance.Hereiswhathappensinatypicalcase.

A man has heard that “carbs are bad” or perhaps notices that his blood

glucosehasgoneupbrieflyafteramealofriceorstarchyvegetables.Hedecides

toavoidcarbohydratesandaddsfishandchickenbackintohisdiet.Atfirst,it

seemslikeagoodchange.Hisbloodglucosedoesnotspikestronglyaftermeals

because there is very little starch in his meals to provide glucose. “Aha!” he

says.“I’vefoundthediettokeepmybloodsugardown!”overthenextseveral

days,however,henoticesthathisfastingbloodglucosevaluesareheadinginthe

wrong direction. They go up bit by bit, and after a week or two, the rise is

significant.“Nowwhat?”hethinks.Thisiswhatisgoingon:

There are only three sources of calories: carbohydrate, fat, and protein. In

avoiding carbohydrate, he was left with fat—which tends to increase insulin

resistance—andprotein,whichhasproblemsofitsown.Theincreasedfatintake

didnotincreasehisbloodglucoseimmediately,butfattydietstendtoincrease

theamountoffatinsidethecells.Theresultisthatinsulinresistancegradually

worsens. This means that any carbohydrate he ate later would cause a bigger

bloodsugarspikethanitotherwisewouldhave.Asthedayswentby,hisblood

sugargraduallyincreased.

Theanswertothisistoavoidfattyfoodsandchoosehealthy,carbohydrate-

rich foods, letting the glycemic index help you choose the best of them (see

Chapter4).Thismeanslegumes(beans,peas,andlentils),vegetables,fruits,and

wholegrains.

Meals will always cause a temporary rise in blood glucose; what you are

looking for is an overall trend downward as your insulin sensitivity gradually

improves.

See your doctor. One common reason for rising blood glucose levels is

infection. A cold, a urinary tract infection, a foot sore, an ear infection—you

name it. They all tend to raise your blood glucose. Sometimes a surprisingly

small cut or a cough you’re hardly aware of boosts your fasting blood sugar

values. As the infection heals (with medical treatment as needed), your blood

glucosewillrecover.Yourdoctormaydecidetoadjustyourdiabetesmedications

intheinterim.

Check your stress level. Stress raises blood sugar. The fight-or-flight

response—the physical reactionthat gets you ready to fight orrun away from

danger—can kick in with any sort of threat, real or imagined. A rise in blood

sugar was much more useful when the threats we encountered were predators

andwarringtribes.Thatextrabloodsugarfueledthemusclesneededtorunor

fight. Today, we are more likely to be threatened by job worries, financial

difficulties,orrelationshipproblems,andrisingbloodsugardoesn’thelpduring

thosetimes.Butstressstillevokestheresponse,anditstillcausesabloodsugar

spike.

If stress is temporary, you will see your glucose spike resolve quickly. If

stressisongoing,gethelp.Meditation,yoga,andothertechniquescanhelpyou

dealwithstress.Iftheproblemisdeeper—ifyouareheadedintodepressionor

chronic anxiety—do not try to be a hero. See a qualified mental health

professionalandgetstartedwithatreatmentthatworksforyou.

Exercise.Ifyouaresedentary,nowisthetimetobringphysicalactivityinto

yourlife.Vigorousexercisehelpsreducebloodglucoselevels.SeeChapter11.

In most cases, these steps will help bring your blood sugar down. If it

remains high despite your best efforts, your doctor will want to adjust your

medications.

PERSISTENTHUNGER

Ifyouarecuttingbackoncaloriesinanefforttoloseweight,youmaybeleft

feelinghungry.OneofthereasonsIrecommendalow-fat,vegandietisthatitis

so substantial—it provides plenty of fiber to fill you up and has no limits on

portion sizes or calories. The result is weight loss without hunger. In our

researchstudies,weuseaquestionnairetomeasurehungeralongtheway,and

weconsistentlyfindthatthiswayofeatingleavespeoplefeelingsatisfied.

Whatifyourmealsdon’tquiteholdyou,though?Herearesomesuggestions,

startingwiththeobviousone.

Eatmore.Maybethatlittlebowlofoatmealisjustnotenough.Whenyou

arejustgettingto knownewfoods,it takesa littletimetofigureout theright

servingsizes.Youwillsoonsortthisout.

Go lowGI and highfiber. If you haveinstant oatmeal for breakfast, you

willgethungrysoonerthanifyouhavetheold-fashionedvariety.Thedifference

is simply that instant oats have had their fiber sliced up. Instead of flat rolled

oats,youhaveaboxfullofoatpowder.Thatmeansthattheycookquickerbut

alsothattheydigestquicker,spikeyourbloodsugarquicker(thatis,theyhavea

higherGI),andleaveyouhungryquicker.Eatingfoodsthatareinasnaturala

state aspossible prevents thatoverly rapid digestionand helps keep hungerat

bay.

YouwantfoodsthathavebothalowGIandhighfibercontent.Afoodthat

offersonedoesn’tnecessarilyhavetheother. Forexample, wholewheat bread

has lots of fiber, but something about the wheat grain causes it to release its

naturalsugarsintothebloodstreamratherquickly(i.e.,ithasahighGI).Infact,

whitebread(whichhashaditsfiberremoved)hasvirtuallythesameGIaswhole

wheat.Incontrast,ryebreaddigestsmoreslowly,releasingitsnaturalsugarsinto

the bloodstream more gradually, which means it has a low GI. To check your

fiberintake,doaQuickFiberCheck.

Havehealthysnacks.Therewillbemanytimeswhenyouwillwanttohave

abitetoeatbetweenmeals,andyoushould!SeeChapter5foradiscussionof

thebestchoices.

QUIETINGCRAVINGS

Ifyouhavehaddiabetesforanylengthoftime,youhavealreadybeencoping

withtheubiquitousnatureofjunkfood.Unhealthysnacksareeverywhere.But

why do they call to us as they do? Why is sugar or chocolate sometimes so

attractive?Whyischeeseormeatsometimeshardtoresist?Wheredocravings

comefrom?

One ofour research participantsonce asked me whatwas wrong withher.

She hadhad diabetes for12 years, and eventhough she knew thatshe should

stayawayfromsugaryfoods,shecravedthem.Especiallywhenshewasstressed

ortired,cookies,chocolate,andpastries seemedtocallhername. Shehad the

cravingsnearlyeveryday.“IthinkI’mjustaweak-willedperson,”shesaid.She

wasembarrassedabouthercravingsandfoundherselfavoidingthesubjectwhen

shespoketoherdietitian.

Hereisthemostimportantthingtounderstandaboutcravings:Theyarenot

causedbyweakwillorgluttony.Cravingsaretriggeredbybiologicalproperties

ofthefoodsthemselves.Thatis,certainfoodshavechemicalmakeupsthatcause

us tocrave them in verymuch the same waythat drugs, alcohol,and tobacco

haveaddictivecomponents.

Letmebeclear:Onlycertainfoodslendthemselvestocravings.Thesame

foodsarealluringtoalmosteveryone.

Fourtypesoffoodstriggerbiochemicaleffectsnotunlikethoseofaddictive

drugs. They are not as strong or as dangerous as drugs, but the chemistry of

addiction does seem to be at work with these foods. I have described these

effects in detail in a book called Breaking the Food Seduction. Here, I will

summarizethemainpointsyouneedtoknow.Thefourcategoriesofaddictive

foodaresugar,chocolate,cheese,andmeat.

Sugar.Sugarisnotsimplysweet.Inadditiontoitstaste,italsohasamild

druglikeeffect.Thatis,itaffectsthebraininessentiallythesamewayasopiate

drugs—morphine and heroin, for example—albeit not as strongly. This effect

helpsexplainwhypeoplecravesugar,especiallyduringtimesofstress.

Howdoweknowthatsugarhasthiseffect?Incontrolledstudies,researchers

useamedicationcallednaloxoneasaresearchtool.Nalox-oneisnormallyused

inemergencyroomstoblocktheeffectsofheroinorotheropiates.Ifaperson

hasoverdosedonheroin,doctorsinjectnaloxone,whichblockstheheroin(and

any other narcotic) from attaching to receptors in the brain. A comatose drug

addict, previously on the verge of death, rapidly awakens with a dose of

naloxone.

Researchers have given naloxone to volunteers and offered them various

sugaryfoods.Theythenmeasuredhowmuchthevolunteersateandcompared

theresultstothoseofthesametestdonewithoutnaloxone.

It turns out that naloxone causes a noticeable drop in sugar cravings.

Normally,youmightlongforaglazeddoughnutorpieceofpie,butwithadose

ofnaloxone,much oftheattractionis gone.Theeffectis particularlyclearfor

foodsthatcontainbothsugarandfat:cookies,cakes,andicecream.

Naloxoneisgivenintravenouslyandisnotatreatmentforfoodaddiction;it

isaresearchtool.Theseexperimentsshowthatsugardoesnotsimplydelightthe

tastebuds;italsostimulatesthereleaseofopiatechemicalsinthebrain.Justas

intenseexercise causesthe releaseofendorphins—natural feel-goodchemicals

withinthebrain—sugarseemstodosomethingverysimilar.

Letmebeclearaboutthis:Sugardoesnotcontainopiates.Rather,thetaste

ofsugaronthetongueiswhatapparentlytriggersthereleaseofopiateswithin

thebrain.Inturn,these opiatestriggerthe releaseof anothernaturalchemical,

calleddopamine,whichisthekeytothebrain’spleasurecenters.Drugsofabuse

—heroin, cocaine, marijuana, tobacco, alcohol, and all others—increase

dopamineactivityinthebrain.Sugarappearstodothesame.Evidencesuggests

thattheeffectsofsugaronthebraineasepainanddiscomfortandgiveusalittle

boost.Nowonderweturntosugaryfoods,especiallywhenwe’restressed.

Sugarhasthesameeffectsoninfantsjustafewhoursold.Whenbabieshave

a heel-stick to draw a blood sample, they cry noticeably less if a bit of sugar

waterisdribbledintotheirmouthfirst.

Sugarcravingsgo beyondplainsugar itself.Somepeople alsocravefoods

suchaswhitebreadorbagels,whichturntosugarrapidlyandreleasesugarinto

thebloodstream.Inessence,theycravehigh-GIfoods—sugar,cookies,crackers,

white bread, potatoes, or cold cereals. While we also enjoy low-GI foods, we

tendnottocravethem.

Chocolate. Chocolate’s addictive qualities have long been recognized in

psychiatric journals. And in scientific studies, the most ardent chocoholics’

desire falls away when they are treated with opiate-blocking drugs. These

experimentsshowthatitisnotsimplytasteormouthfeelthatkeepsushooked.

Chocolatealsoappearstohavemildeffectsonourbrains.

Chocolate’s attractionis not due simply to its sweetness.After all, no true

chocolate lover would be satisfied with sugar alone. Chocolate also contains

caffeine,theobromine,andphenylethylamine.Theseareallstimulants,andthey

mayplayaroleinchocolate’sseduction,asidefromitsopiateeffects.

If you are a chocolate lover, you probably already know that chocolate is

more than a food: You don’t just feel you want it, you feel you need it.

Regrettably, chocolate carries not only a load of sugar but also a considerable

loadoffat.

Cheese.Yes,itmaysmellabitlikeoldsocks,butcheeseisoneofthefoods

thatpeoplewhoaretryingtoimprovetheirdietshavethemosttroubleleaving

behind.Thereisobviouslysomethingbesidesfatandcholesterolincheesethat

accountsforitspopularity.

That “something” may be the dairy protein, or casein. Like all proteins,

casein’smolecularstructureislikealongstringofbeads,witheachbeadbeing

an amino acid. Normally, when proteins are digested, these amino acids come

apartonebyoneandareabsorbedintothebloodstreamtobeusedtobuildbody

tissuesandrepairanydamagetoyourbody.

Casein behaves differently. As it breaks apart, it does not simply release

individual amino acids. It breaks into short strings of amino acids—strings of

perhapsfour,five,orseven“beads.”Theyarenotjusttheaminoacidbuilding

blocks for protein; they are also biologically active compounds with a mild

narcoticaction.Scientistscallthemcasomorphins—casein-derivedmorphinelike

compounds.Ifscientistsweretofeedyoucheeseandthentakeasampleofyour

digestive tract contents, they would find an array of casomorphins with mild

narcoticactions.Somehavespeculatedthatthenarcoticeffectsofcasomorphins

are responsible for cheese’s attraction. These effects may also explain why

cheesecanbeconstipating,sincenarcoticcompoundsslowdigestion.

By now you know if cheese is your thing. If so, its fat and cholesterol

contentsareconspiringagainstyou.Shortly,wewilllookathowtokickthisand

otherfoodaddictions.

Meat. Men, in particular, often describe meat as the very last food they

wouldeverwanttogiveup.Nomatterhowoftentheyareremindedofwhatitis

doing totheir waistlineor cholesterol testresults, many have trouble breaking

theiremotionalattachmenttoroastbeef,steak,orchickenwings.

Onceagain,experimentswithopiate-blockingdrugssuggestthatpartofthe

desireformeatmayhaveitsbasisinopiateeffectswithinthebrain.Researchers

inEnglandgaveopiate-blockingdrugs tovolunteersandtestedtheirdesirefor

ham, salami, and tuna. The results showed that when the opiate effects were

blocked,volunteerslostmuchoftheirinterestinmeat.

RESETTINGYOURPRIORITIES

Ifcravingsare sabotagingyournewfood program,takeheart.You arenotthe

victimofabadupbringingoragluttonouspersonality.Thefactis,youarenot

attractedtojustanyfood,oreventomostfoods.Youmaylikeapples,oranges,

bananas,orasparagus,butyouhaveneveronceturnedtothemforsolaceduring

momentsofstress.Youhaveneverracedofftoaconveniencestorebecauseyou

just had to have cauliflower. You have turned to sugar, chocolate, cheese, or

meatbecausetheyhavechemicaleffectsonthebrain.Somebeverages,suchas

wine or coffee, also have druglike effects and can be addictive. But as far as

foodsgo,thosefouraretheonesthatworktheirunfortunatemagiconjustabout

everyone.

Before we see what you might eat instead of that sugary doughnut, candy

bar,orcheeseburger,let’stakeacloserlookatwhathappensinsideyourbrain

whenyoueatthesefoods.

Anetworkofcellsdeepinsidethebrainmakesupwhatissometimescalled

yourrewardcenter.Indeed,itisresponsibleforfeelingsofpleasure.Withoutit,

lifewouldbeonebiggrayday.

Therewardcenterisnottherejustforfun,however.Itistheretokeepyou

aliveandtomaintainthespecies.Hereiswhy:Ifyougotabsolutelynopleasure

fromeating,youmightforgetaboutfoodsentirely!Likewise,ifsexwereatotal

bore, the species would soon die out. Thus, when you eat or have sex, your

rewardcentergivesyoualittlebitofdopamineasakindofreward.

In the process, that dopamine release causes slight neurological changes,

changesthatputhigh-prioritystatusonrepeatingwhateveryouhavejustdone.

“That was fun,” your reward center seems to say. “Let’s be sure to do that

again.”

Innature,thiswouldmeangettingarewardforfindinganewfoodsourceor

a receptive mate, with the result that you would take advantage of your find

again and again. The problem is that this system is easily hijacked. Alcohol,

recreational drugs, tobacco—and yes, unhealthy foods—cause significant

dopamine release, so not only do you like them, you also want to have them

again and again. Your pleasure center rearranges your priorities to favor

whatever stimulated it most recently. You find yourself planning your day

aroundsugarorchocolate,justasanalcoholicmightregularlythinkaboutwhere

thenextdrinkiscomingfrom.Ifyouhaveeverwonderedwhytheseotherwise

banal foods have such sway, it is because they hijack your brain’s pleasure

circuitryandyourinternalpriority-settingsystem.

BreakingFree

Iftheoccasionaltasteofsugarorchocolateisreallynotabigpartofyourlife,

thereisnoneedtoworryaboutit.Butifyourwaistlineisexpandingbeforeyour

veryeyes,oryourhealthissufferingfromyourfoodhabits,itistimetowakeup

andsmelltheaddiction.Whatdoyoudoifyou’rehooked?

Thebestwaytodealwithunhealthyfoodsistoavoidteasingyourself.Set

themasidecompletely,atleastfornow.Donotkeeptheminthehouse,anddo

notbuythem.Thereisnoneedtoworryaboutwhetheryouwillreturntothem

inthefuture.Fornow,justleavethemalone.

In the process, your brain’s prioritiescan return to what really is good for

you.Youarelikelytofindthatyourdesireforunhealthyfoodsfadesthelonger

youareawayfromthem.Thefollowingstepswillalsohelp.

• Eatahealthybreakfast,anddon’tskipmeals.Cravingskickinwhenyouare

hungry.

• Getregularexercisesoyou’retiredenoughtosleepsoundly,andbesureto

getplentyofrest.Cravingsarestrongerwhenyouarenotsleepingwell.

• Avoid situationsthat triggercravings. Somepeople findthat theircravings

are triggered by being alone, by television cooking shows, by concession

standsatmovietheaters,orbycertainfriendswhoarepreoccupiedwithfood

problems oftheir own. Try to identify yourtriggers and eliminatethem as

muchaspossible.

GettingtheTastewithouttheRegrets

Sometimes a simple substitution can help you steer away from an unhealthful

food.Hereareafew.

Ifyoucravesugar:Inrecipes,maplesyrup,molasses,sorghumsyrup,and

granulated sugarcane juice (Sucanat) can sometimes substitute for table sugar.

Thesearehardlyhealthfoods!Buttheideaistoreplacerefinedwhitesugarwith

asmalleramountofsyruporjuice.They’resoflavorfulyouwon’tnoticeyou’re

usingless.

SteviaisanintenselysweetderivativeofanherbfromParaguay.Itissoldas

a dietary supplement (its use as a commercial food additive has not yet been

approved).

Sucralose (Splenda) is a calorie-free sweetener made from cane sugar to

whichchlorinehasbeenchemicallyadded, greatlyincreasingthe sweetnessof

thefinalproduct.Sugaralcohols,suchasmannitol,sorbitol,andxylitol,arelow-

caloriesweetenerssometimesusedincandies,chewinggum,anddesserts.They

haveabouthalfthecaloriesoftablesugar.Thereare,ofcourse,otherartificial

sweeteners. The disadvantage of the lot of them is that they do not help you

break your love affair with sweets, so when artificial sweeteners are not

available,youwillfindyourselfreturningtosugar.

MyfriendandcolleagueHansDiehl,DrHSc,founderoftheCoronaryHealth

Improvementproject,says thebestthingtodo forasweet toothisto “haveit

pulled!”Theideaisthatifyousetsweetsaside,youwilleventuallyjustforget

aboutthem.

Of course, the best choices are fresh fruits—nature’s sweet foods. It also

helpstomakesureyourdiethasadequatecomplexcarbohydrate—grains,sweet

potatoes,andbeans,forexample.Thesefoodsprovidetheenergyyouneedina

formthatismuchmorehealthfulthansugar.

If you crave chocolate:Cocoa powderis essentiallydefatted chocolate. It

canbeusedinbeveragesandbakingorturnedintoadipforstrawberriesorother

freshfruit.Youcanalsofindlow-fatfrozenicecreamsubstitutesmadefromsoy,

aswellassorbets.

Ifyoucravecheese:gettoknownutritionalyeast.Soldinthesupplement

aisleofhealthfoodstores,nutritionalyeastflakes(notbrewer’sorbaker’syeast)

addacheeselikeflavortosaucesandcasseroles.

In recipes, you can replace ricotta or cottage cheese with mashed, water-

packedtofumixedwithalittlelemonjuice.Ifyou’rechoosingsoycheeses,read

thelabel tocheck thefat contentand tosee whetherthey’re madewith added

casein,thedairyprotein.

If you crave meat:Good substitutesfor hotdogs, burgers,and delimeats

arenowwidely available.Seitan (madefrom wheat gluten),tofu, tempeh, and

texturedvegetableproteinareversatileproductsthatsubstitutewellformeatin

recipes. Surprisingly enough, the desire for meat fades very rapidly once it is

removedfromthediet.Peoplewhothoughttheycouldnotlivewithoutsteakor

asalmonfilletsoonfindtheyhaveabsolutelynodesireforit.

GeneticInfluencesonCravings

Althoughcravingscanaffectanyone,somepeoplemaybeespeciallyvulnerable.

Researchers have found that some people are born with fewer receptors for

dopamine, the brain chemical responsible for pleasurable feelings. Apparently,

thislackofreceptorsmeansthattheygetlessdopaminestimulationandlessof

thefeel-good sensationthat dopamineprovides. Thisleavesthem feelinga bit

outofsortscomparedwithotherpeople.Asaresult,theyaredrawntotobacco,

alcohol,or drugs; presumably, they areseeking thestimulation that naturehas

notgiventhem.Theymayevenfallpreytocompulsivegamblingorcompulsive

eating.

Itallstartswithagene.Thereceptorsfordopaminearebuiltaccordingtothe

specificationsonyourchromosomes—thelongspiralstaircase–shapedstringsof

genesineachofyourcellsthatdeterminewhoyouare.Yourmotherandfather

passed along their genes to you, and the makeup of your body reflects the

combinationofthetwo.Ifeitherparentpassedalongageneforhavingtoofew

dopamine receptors, you would have roughly one-third fewer receptors than

otherpeople.

If you were able to sample individuals in smoking cessation programs or

drugtreatmentclinics,youwouldfindthatasmanyas40percenthaveagene

that causes them to have too few receptors, called dopamine receptor D2, or

DRD2forshort.

Several years ago, I found myself wondering if people who have trouble

followingahealthfuldietmayhavethisgeneticvariation.ErnestNoble,MD,of

the University of California, Los Angeles, conducted genetic analyses on our

patients.Tooursurprise,wefoundthatnearlyhalfofourresearchparticipants

with type 2 diabetes hadthegene that was associated with fewer than normal

dopaminereceptors.Thatisfarhigherthantheroughlyone-in-fiveprevalencein

thegeneralpopulation.

This raised a disturbing question:Did the lack of dopamine receptors lead

themtoovereat?Didovereatingthenleadtoweightgain,whichinturntriggered

diabetes?Wehavenotyetsortedallthisout,butwedidfindthatwhilepeople

withthisgeneimprovedagreatdealonourdiet,theygotsomewhatlessbenefit

comparedto thosewith thenormal numberof dopaminereceptors.Their A1C

valuesdroppedbyabout0.9percentagepointonaverage,comparedtoadropof

1.6pointsforthosewithoutthegene.Atpresent,thistypeofgenetictestingis

done only in research studies. Your doctor cannot determine whether you are

geneticallyendowedwithfewerdopaminereceptors.Infact,asfarasyourfood

planisconcerned,itdoesnotmatter.Regardlessofyourgeneticmakeup,thediet

described in this book is very likely to help you. I raise the issue of genetics

simply to underscore the point that cravings and food addictions are physical,

notmoralissues.Theyareduetothepropertiesoffoodsthemselvesthatinteract

withournaturalbiochemistry.

One final point: If certain foods act like drugs, it pays to treat them like

drugs.Inotherwords,avoidthem.Justasitisharderforasmokertocutdown

than to quitand harder for an alcoholic to drinkwinemoderately than to quit

drinkingaltogether,itisverytoughtoteaseyourselfwithfoodsthathaveyouin

theirclutches.Itisactuallyeasierto leavethem alonecompletelyand doyour

besttoforgetaboutthem.Ifyouhavenothadoneofthesebiochemicallyactive

foods in a few weeks, you crave it much less than you would if you had it

yesterday.

Thebraincellatthetopcontainssmallpackets(vesicles)ofdopamine.Whenyouexperiencea

pleasurablesensation, these vesicles release their dopamine into the space (synapse) that lies

betweenthatcellandthenextone.Asthedopaminemoleculesreachthenextcell,theyattachto

its dopamine receptors, and their effect depends on how many dopamine receptors you have.

Somepeoplehaveapproximatelyone-thirdfewerreceptorsthanotherpeople.

DIGESTIVEPROBLEMS

Aplant-baseddietisgreatforpeoplewhohavebeenbotheredbyconstipation.

Itsnaturalfiberiswhatyourdigestivetractneeds.Somefoodscancauseabitof

gassiness,however.Ifyouexperiencethis,hereiswhattodoaboutit.

First,onlycertainfoodscausegas.Grains,fruits,andmostvegetablesgeta

not-guilty verdict. Beans and undercooked cruciferous vegetables (broccoli,

cabbage,cauliflower, andBrussels sprouts,for example)are themain culprits.

Chances are, all you need to do is have smaller servings. If you have been

replacingahugesteakwithahugeplateofbeans,rememberthatasmallamount

ofbeansgoesalongway.Trydownsizingyourportions.

Over time, you will find that your body adjusts, so you can have larger

portionswithlessgassiness.Ifyoucookbeansfromscratch,besuretodiscard

thewaterusedtosoakthemandthencooktheminfreshwater.Cookthemwell

(therearenoaldentebeans)!Thesamegoesforcruciferousvegetables.Yes,we

all love a stalk of fresh broccoli from the crudités tray, but if that gives you

digestivetrouble,cookvegetablesuntilyoucaneasilypiercethemwithafork.

Itgoeswithoutsayingthatyouwanttoavoiddairyproductsandsugar.Dairy

products, of course, are already off the list, but digestive problems are yet

anotherreasontosteerclearofthem,asyousawinChapter4.Thelactose(milk

sugar)thatmakesupfully55percentofthecaloriesinfat-freemilkcausesmany

peopletohavegas,cramps,anddiarrhea.Hereiswhy.

Duringinfancy,thelactaseenzymeisproducedwithinthebodyandbreaks

lactose apart in the baby’s intestinal tract so it can be absorbed and used for

energy.Aschildrenleaveinfancybehind,however,mostlosethisenzyme.The

result,lactoseintolerance,wasoncethoughttobeabnormal,butitisnowknown

tobethebiologicalnorm,notonlyforhumansbutforallmammals.Becausethe

body’s lactase production slacks off gradually, many people do not make the

connectionbetweentheirdigestivesymptomsandmilkproducts.

In about 85 percent of Caucasians, a genetic mutation causes the lactase

enzyme to persist well into adulthood. Even so, lactose intolerance will

eventuallyaffectmanyofthem,too.Deletingdairyproductsfromthemenufora

fewdayswillshowyouwhetheryouareamongthem.

Some adults have trouble digestingtable sugar (sucrose). Once again, it is

easy to check. Simply set it aside for a few days and see if your symptoms

improve.

HIGHTRIGLYCERIDES

Whenyourdoctorchecksyourcholesterol,triglycerideswillalsobelistedonthe

laboratoryreport. Triglycerides aremolecules of fatthat aretransportedin the

blood for various purposes. As with cholesterol, having a certain amount of

triglycerides in the blood is a normal part of human biochemistry. However,

whentriglyceridesarehigh,theyincreasetheriskofheartproblems,diseasesof

thepancreas,andotherproblems.AsyousawinChapter7,anormaltriglyceride

concentrationislessthan150mg/dl.Valuesof150to199mg/dlareconsidered

borderline, and values of 200 to 499 mg/dl are high. Concentrations of 500

mg/dlorhigherareconsideredveryhigh.

Some studies have suggested that diets high in refined carbohydrates may

causeatemporary risein triglycerides.High-fiberand low-GIfoods appear to

havetheoppositeeffect.

Youwillwanttomakeaspecialpointoffavoringthese

foods. In our research, a low-fat, low-GI, vegan diet brings down triglyceride

levelsveryeffectively.Inaddition,alow-fat,vegandiethelpsyouloseweight,

whichinturnreducestriglycerides.

Regular exercise helps, too. Moderate physical activity, such as walking,

lowers triglyceride concentrations. You will also benefit by avoiding alcohol.

Alcoholappearstoraisetriglyceridesslightly,sowhenyouavoidit,triglycerides

slidebackdown.

INTERACTIONBETWEENVEGETABLESANDPRESCRIPTION

BLOODTHINNERS

Warfarin (Coumadin) is a blood thinner prescribed to prevent heart attacks,

strokes,bloodclotsinthelegs,andotherproblems.Itactsbyantagonizingthe

effectsofvitaminK,whichisinvolvedinbuildingtheproteinsyourbodyusesin

theclottingprocess.

Many people taking warfarin believe they have to avoid vegetables,

especiallygreenleafyvegetables,thatarerichinvitaminKbecausethevitamin

willaffecttheirtendencytoformclots.Butavoidingthesehealthfulfoodswould

leavethemverylowinimportantvitaminsandminerals.

Iencourageyoutodiscussthisissuewithyourdoctorandyourdietitian,but

theanswerisnottoavoidvegetables.Whatmattersismaintainingafairlysteady

amount of them in your diet so your warfarin dosage does not need to be

continually adjusted. If you eat lots of healthy vegetables and then suddenly

stop,warfarin’sactionsbecomestronger,increasingtheriskofbleeding.Onthe

other hand, if you were to generally avoid vegetables and one day suddenly

increase your intake, the vitamin K in these foods would have the opposite

effect, making it easier for your body to form clots. Bottom line: Enjoy

vegetablesandkeeptheamountfairlyconstantfromdaytoday.

By the way, alcohol increases warfarin’s effects, which is why doctors

encourage people taking it to avoid alcohol. Many medications (e.g., aspirin,

acetaminophen,andmanyothers)canalsoaccentuatewarfarin’saction.

If you have hit any bumps in the road, I hope you have found these

suggestionshelpfulandthatyouarenowbackontrackwithahealthfuldiet.

CHAPTER10

WhichSupplementsShouldYouTake?

News stories and advertisements trumpet the benefits of various nutritional

supplements.Drugstoresandhealthfoodshopsarestockedwithshelfaftershelf

ofthem.Whichoneshelp,andwhichonesareunnecessary?

Here is some basic information that will help you decide. You should,

however, talk to your doctor, nurse practitioner, pharmacist, or dietitian about

whichproductsyoumaytake.Youmayhaveaparticularneedforoneoranother

supplement depending on your health. Or you may need to avoid certain

productsbecausetheyinterferewithmedicationsyouaretaking.

Ifyouareaddingsupplementsthatmightaffectyourbloodsugar,besureto

checkyourbloodglucoseregularly.RefertoChapter7forhowtorecognizeand

treatlowbloodsugar.

Let’slookatspecificvitaminsandothernutritionalcompounds,startingwith

thebasics.

Vitamin B

. This vitamin is essential for healthy blood cells and nerve

function.If you followa vegan diet,as Irecommend, you shouldtake adaily

vitaminB

supplement thatprovides atleast 5micrograms. Nearlyall brands

containmorethanthis,buthigherdosesarenottoxic.Manypeople,particularly

olderpeople, tendto runlowon vitaminB

regardless oftheirdiets, because

their bodies become less efficient at absorbing it. That is also true of people

takingmetforminoracid-blockingmedications.Yes,youcanfindvitaminB

in

somefortifiedproducts,suchasbreakfastcerealsandsoymilk,buttheamounts

maynotbeenoughtomeetyourneeds.

VitaminD.VitaminDisproducedwhenyourskinisexposedtosunlight.It

helpsyouabsorbcalcium,amongotherfunctions.Itisagoodideatospend15to

20 minutes daily outdoors. If you get this sun exposure, there is no need for

dietary supplementation. If you do not and also do not take a regular

multivitamin,a2,000IUvitaminDsupplementisagoodidea.

Asidefromthebasicvitamins,someothersupplementshaveshownpromise

forpeoplewithdiabetes.

Cinnamon. Cinnamon has been shown to improve blood sugar levels. As

little as ½ teaspoon of ordinary cinnamon added to your morning oatmeal or

other foods not only seems to reduce blood sugar, but also appears to reduce

bloodcholesterollevels.

Someofcinnamon’shelpfuleffectsmaybeexplained

by compounds called polyphenol polymers, which are found in the spice and

haveaninsulin-likeaction.

Magnesium. In harvard’s Nurses’ health Study, women who had more

magnesium in their diets had a significantly lower likelihood of developing

diabetes.

Apparently,magnesiumincreasesinsulinsensitivityandmayincrease

the secretion of insulin from the pancreas, which suggests that it may also be

helpfulafterdiabeteshasbeendiagnosed.

Thisdoesnotmean,however,thatyouneedamagnesiumsupplement.Foods

rich inmagnesium include whole grains(grains with their naturalfiberintact)

suchasbrownrice,barley,andoats,aswellasgreenvegetablessuchasspinach

andSwisschard.Manybeanvarietiesarealsorichinmagnesium.

Chromium.Chromiumisanelementthathelpsinsulinworkbetter,meaning

thatithelpsthehormoneescortglucosefromyourbloodstreamintoyourcells.

Technically speaking, chromium is what is called an insulin cofactor—an

insulinhelper,ifyouwill.Inthesamewaythatyoucannotuseajacktoliftyour

carifitshandleismissing,insulinhastroublebringingglucoseintocellswithout

chromiumtohelpitworkproperly.

Chromium’sessentialrolewasdiscoveredonlyrelativelyrecently.Inthelate

1960s, researchers found that chromium deficiency could lead to high blood

sugarlevels.

In1977,Canadian researchersdescribedthe caseof awomanin

her midthirties who was receiving all her nutrition intravenously following

intestinalsurgery. Astime wentby,shebegantoloseweight. Herblood sugar

startedtoriseinexplicably,andeventually,shedevelopednervesymptomsinher

legsthatappearedtobediabeticneuropathy.Herdoctorshadtoadministerlarge

insulindosestobringherbloodsugarundercontrol.Eventually,theygaveher

chromium, which had been absent from her feeding formula. In just a few

weeks,herbloodglucosefelltothepointwhereshenolongerrequiredinsulin,

andhernervesymptomsdisappeared.

Chromiumisnaturallypresentinmanyfoods,suchasbroccoli,greenbeans,

whole grains, nuts, and even coffee. Some experts recommend taking

supplementsaswell.

Whichfoodshaveit,andhowmuchdoweneed?AccordingtotheFoodand

NutritionBoardoftheInstituteofMedicine,thesafeandadequatedailyintakes

of chromium for adults ages 19 to 50 are 35 micrograms for men and 25

microgramsforwomen.Forpeopleover50,theamountsare30microgramsfor

men and 20 micrograms for women. Here is the amount of chromium in

commonfoods,aslistedbytheUSgovernment.

ChromiumContentofCommonFoods

FOOD PORTION CHROMIUM(MCG)

Broccoli ½cup,cooked 11

Grapejuice 1cup 8

Englishmuffin,wholewheat 1 4

Potatoes,mashed 1cup,cooked 3

Garlic,dried 1teaspoon 3

Basil,dried 1tablespoon 2

Orangejuice 1cup 2

Wholewheatbread 2slices 2

Redwine 5ounces 1–13

Apple,withskin 1medium 1

Banana 1medium 1

Greenbeans ½cup,cooked 1

Source: National Institutes of Health, http://ods.od.nih.gov/factsheets/Chromium_pf.asp#h2,

accessedApril10,2017.

Whileyouaremakingsuretoincludechromium-richfoodsinyourmenu,it

mayalso help tosteer clearof sugarand refined grainproducts such as white

flour.Thesefoodsarenotonlylowinchromium,theyalsoincreasechromium

loss from the body. Loss of the mineral is also increased by the stresses of

infection,strenuousexercise,andpregnancy.

Some researchers have gone beyond foods and have tested the effects of

supplements. However, studies in which researchers gave chromium to people

with type 1, type 2, or gestational diabetes have yielded mixed results. The

problemmaybethatsomestudiesweresmallandusedrathersmallchromium

doses,but some studiesusing higherdoses inindividualswith type2 diabetes

haveshownnobenefit.

Asaresult,mostdiabetesauthoritiesdonotrecommend

chromiumsupplements.

Ifyouaregoingtosupplement,youshouldbeawarethatthesafetyofhigh

chromium doseshas not beenas extensively studied asthat of otherminerals.

Studies using chromium for diabetes treatment often exceed the amounts

recommendedbytheUSgovernment,usingdosesofupto1,000microgramsper

day. Individuals with impaired liver or kidney function may be at risk for

adverse effects and should probably stay well below this level. The long-term

benefitsandrisksofchromiumsupplementationarenotknown.

Alpha-lipoic acid. Alpha-lipoic acid, sometimes called thioctic acid, is

naturally produced in the human body. It plays important roles in the

mitochondria, the microscopic “burners” that provide energy in the cells. It

worksasacofactorforseveralenzymesrelatedtoenergymetabolism.

Supplementalalpha-lipoicacidisusednottocounteractdeficienciesbutto

actessentiallylikeadrug.Inhighdoses,itactsasanantioxidant.Inpeoplewith

type2diabetes,itappearstoincreaseinsulinsensitivityandreducesymptomsof

nervedamage.

6,7

Inmanystudiesofalpha-lipoicacid,researchersusedintravenousinfusions

ratherthanoraldoses.Sofar,itappearstobesafe,butitisnotyetclearwhether

itwillyieldclinicallyimportanteffectsoverthelongrunandifso,whatdoses

aresafeandeffectiveforlong-termuse.

ForFurtherReference

If you search for information about supplements on the Web, you may find

yourselfcarriedawaybyafloodofcommercialsites.IrecommendthisNational

InstitutesofHealthsite,cc.nih.gov/ccc/supplements.

CHAPTER11

ExercisefortheRestofUs

Yes,exerciseisgoodforyou.Physicalactivityreducesyourbloodsugarandis

good for your heart. It improves the quality of your sleep and your overall

energylevel.Whenyougetintoanexercisegroove,youreallyfeelgreat.

Formanyofus,however,exerciseconjuresupimagesofpainfulworkouts

and unrewarding drudgery. Many people have trouble getting into an exercise

routine; it just does not seem to work for them. For every person I hear say

somethinglikethis:

“IfeelsogoodwhenIexercise.Ihavemoreenergy,mybloodsugar

comeswaydown,andIjustfeelgreat.Ican’timagineadaywithoutit.”

…there’sanotherwhofeelsmorelikethis:

“Ireallyjustcan’tgetintoexercise.IknowI’ddobetterifIdid,but

everytimeIjoinagymorresolvetostartexercising,itjustdoesn’tlast.”

If you are carrying around a lot of extra weight, exercise can be difficult.

Perhaps you are limited by joint pain or heart problems. Maybe your good

intentionsjustseemtovanishwhenthetimecomestolaceupyoursneakers.In

this chapter, we will tackle the various aspects of exercise—its benefits, its

limitations,andthedifficultiesingettingstarted—andseehowtomakeitwork

foryou.

One note of reassurance: If you cannot exercise because of a physical

limitation,youcanstillloseweight,cutyourbloodsugar,andliveahealthylife.

In fact, most of the benefits of the diet changes you have read about came

without exercise. That is because in our diet studies, we usually ask our

volunteersnottoaltertheirexercisepatterns,sowecanisolatetheeffectsofa

dietchangeforresearchpurposes.Exercisecertainlyaddstothehealthbenefits

thatagooddietbrings,butifitissimplynotinthepicture,youcanstilldowell.

WHATYOUAREWORKINGFOR

Differentkindsofexerciseprovideverydifferentbenefits.

Aerobicexercise is any sort of rhythmic, continuous activity you perform

for a sustained period—usually at least 10 minutes. Brisk walking, running,

playing tennis, dancing, or skating can all be aerobic. This type of exercise

reducesyourbloodsugarandtriglycerides,andifyoukeepitup,youwilllive

longer.

Resistance exercise is weight lifting and other exercises in which the

emphasis ison muscular effort: pushups and deepknee bends, for example.It

builds your muscle mass or at least preserves the muscle you have. It also

improvesinsulinsensitivity.

Flexibility exercises (stretching) are intended to maintain the range of

motionofyourjoints.Theycanalsorelievestress.

Below,Iwillgiveyouguidelinesforhowmuchandhowoftenyoushould

exercise.

Adiet–exercisecombinationcanhelppreventdiabetesfromeverdeveloping.

AgroundbreakingstudycalledtheDiabetesPreventionprogramfollowed3,234

people whose blood sugar levels were creeping upward but were not yet high

enough to warrant a diagnosis of diabetes. With a combination of diet and

exercise,theparticipantswereabletocuttheriskofdevelopingthediseaseby

58percent.Theexerciseregimentotaled150minutesperweek—ahalfhourfive

timesaweek.

There is a very big caveat with all of this, though: Exercise can boost the

effectsofahealthydiet,butitcannotmakeupforapoorone.Infact,ofthetwo

components—diet and exercise—the diet portion is much more important for

weightlossandultimatelyforpreventingorcontrollingdiabetes.

A careful review of published research showed that people who begin

exercise programs do not lose much more weight than people who remain

sedentary.

Forweightcontrol,exercisecannottaketheplaceofdietchanges.

Thisdoesnotmeanthatexerciseisofnohelpatall.Itisdefinitelyhelpful

forreducingA1C.Inareviewofseveralstudiestestingtheeffectofexercise,the

average A1C in volunteers who began exercise programs fell to 7.7 percent,

whichisbetterthanthe8.3percentfoundinthosewhodidnotexercise.

Once

again,however,thatresultpalesincomparisontothebenefitsofadietchange.

To prevent diabetes or bring it under control, it is best to use both diet and

exercise.

onepartofyourbodythatbenefitstremendouslyfromexerciseisyourheart.

Arecentstudytrackedphysicalactivitylevelsinadultswithtype2diabetesover

aperiodof19yearsandlookedspecificallyattheriskofdyingofheartdisease.

It turned out that those who were moderately physically active were about 40

percentlesslikelytosuccumbtoheartdiseasethanweresedentarypeople.Their

routines included at least 4 hours per week of moderate exercise such as

walking,cycling,orlightgardening.

Activepeoplealsocuttheirriskofstroke.

There are three other exercise benefits worth noting. First, exercise and

eating are mutually exclusive activities. It is easy to scarf down extra calories

whilewatchingyourfavoritecrimedramaoramovie,butitisarealchallenge

whileyouareplayingtennis.Exerciseiscalorie-freefun.

Second, exercise helps you sleep. If you have given your muscles a good

workout,theydemandsleep.Youwillsleepmuchmoresoundlythanifyouhad

spenttheentiredaybehindyourdesk,watchingtelevision,orreading.Andwhen

youarewellrested,itiseasiertostayfocusedonahealthydietandsaynoto

unhealthfulfoods.

Third, exercise makes you feel better. It lifts your spirits and is a natural

antidepressant.

TYPEIANDTYPEIIMUSCLECELLS

Why do some people love exercise and others loathe it? Surprisingly enough,

partofthereasonisgenetic.Ifyoucouldlookinsideyourmusclesandcompare

them with those of other people, you would discover a sobering fact: Some

people were born to exercise. That is to say, their muscles naturally contain

manytypeIcells(thenamehasnothingtodowithtype1diabetes;itisjusta

coincidence).Thesemusclecellshaveaparticularlystrongbloodsupplymade

possiblebyarichnetworkofcapillariesthatbringinoxygenandreducefatigue.

They also have an extra supply of an enzyme called lipoprotein lipase, which

breaks fats apart to be used as fuel. The result is extra energy for a long run.

When you see people running down the road looking invigorated rather than

haggard,orwhensomeonewaxespoeticaboutthejoysoftherunner’shigh,do

not envy their resolve. Odds are, they were born with muscles that are just

loadedwithtypeIcells.

Otherpeople’smusclescontainmostlytypeIIcells,whicharefineforshort

burstsofexercisebuthavelessenduranceforthelonghaul.

Now,havingsaidthat,itisimportanttorealizethatmusclescanchange,at

least to a degree. If you gradually but steadily increase the intensity of your

workouts(withinthelimitsofsafety),thebloodsupplytotypeIIcellsincreases.

Eventually,theybecomealmostasvigorousastypeIcells.

I raise this biological distinction to make an important point: Exercise

aptitude—orlackofit—isnotaquestionofcharacter;itisbiologyatwork.If

youhavebeenbeatingyourselfupforyourlackofathleticprowess,itistimefor

areprieve.

MAKINGITWORKFORYOU

Therearetwokeystomakingexercisework.

First,let’skeepitfun.Formostofus,thatmeansitshouldbeasocialevent.

Itismorefuntogowalkingwithsomeoneelsethanbyyourself.Ifyouplanto

exerciseatagym,youaremuchmorelikelytofollowthroughifyousignupfor

aclass—aerobics,yoga,orwhatever—thanifyougoitalone.Youarealsomuch

morelikelytoactuallygettoyourclassifsomeoneisgoingwithyou.

You might make an occasion of it and plan an especially healthful meal

afterward.Ifyouaregoingdancingorplayingtennis,thewordexercisemaynot

evenenteryourmind.Youractivityistooenjoyabletocallitthat.Keepitfun

becauseotherwise,youwillnotdoittwice,muchlessthreetimesaweek.And

formostpeople,funmeansfriends.Youneedotherpeoplewithyoutomakeit

work.

Second, it is important to exercise regularly rather than intermittently. To

paraphraseNewton’sfirstlawofmotion,“anobjectatresttendstostayatrest,

andanobjectinmotiontendstostayinmotion.”Iftheobjectatrestisyou—that

is,ifyouarefirmlyplantedonthecouch—youwilltendtostayatrest.If,onthe

otherhand,youandafriendgoforawalkeveryotherdayafterdinner,youwill

stayontrack.

Oneimportanttip:Asyouget readyfor anexercisesession,youwillhave

somemisgivings.Thelittledevilonyourshoulderwilltellyouthatyouaretoo

tired,youdon’thavetime,youjustdon’tfeellikeit,etc.Butthefactis,youwill

never feel like it right at that “getting ready” moment. So don’t wait for that

perfectdaywhenyouwill“feellikeit.”Justdoitanyway,anddoitnow.Geton

outthereanddoyourthing.Andverysoon,you’lldiscoverthatyouaregladyou

did.

Thiscyclewillrepeatitselfeverytimeyouexercise—feelingsofmisgivings

and negative thoughts, followed by your resolve to just ignore that negativity

anddoitanyway,followedbybeingsogladthatyoudid.Andbeforelong,your

confidencewillgrowandyou’llgetintoagroove.

Thereisanotherreasonforkeepingexerciseregular:Theeffectofanysingle

exercisesessionissmall.Ifyoubelongtoagym,youcanseethisforyourself.

Justjumponthenearesttreadmillandrunflatoutforamile.Then,asyoucatch

yourbreath,pushthelittlebuttonthatletsyouseehowmanycaloriesyouhave

burned. Surprised? That’s right, you have expended only about 100 calories.

That’s less than half the calories in an order of McDonald’s french fries or a

bottleofsoda.Asingleexercisesessioneverynowandthenwillnothelpyou

anymorethanoccasionallyeatingahealthymeal.Tobereallyeffective,healthy

habitshavetobepartofyourroutine.

Also,for better orworse, exercise effects donot last verylong. If youare

laid up with an injury, for example, you will find your blood sugar or weight

graduallyreturningtoitspre-exerciselevel.Peoplewhogetintoahabitofgoing

forabriskwalkorbicyclerideeverydayortwosustaintheirbenefits.

Bottomline:Tomakeexercisework,keepitfun,andkeepitregular.

SEEYOURDOCTORFIRST

Before you embark on a new exercise program, be sure to get your doctor’s

okay.Isyourheartuptoit?Areyourjointsready?Howvulnerableareyouto

hypo- or hyperglycemia? Do you have any special eye or foot problems that

could be aggravated by exercise? Your doctor should address all of these

questions.

Bewareofjumpingintovigorousexercisetooquickly.Ifithasbeenmonths

(oryears)sinceyoutriedexercisingregularly,startslowly.Ittakestimeforyour

body to reap the rewards of your new, improved diet. A heart patient, for

example,whobeginsavegandiet,stopssmoking,andstartsreallytakingcareof

himselfwillprobablyfeelbetterverysoon.Hischestpainmaymeltawaywithin

afewweeks,andhewillbeeagertojumpintoavigorousexerciseprogram.The

factis,though,thathestillhasthearteryblockageshehasbeenaccumulatingfor

years.Yes,thedamagecanbereversed,butittakestime,andheshouldnotpush

himselfpastthelimitssetbyhisdoctor.

If you have type 1 diabetes, you may find that your blood sugar drops

precipitouslyduringandafterexercise.Thiscanalsohappentopeoplewithtype

2diabeteswhouseinsulinordrugsthatcauseinsulinsecretion(e.g.,glyburide,

glipizide,glimepiride,nateglinide,orrepaglinide).Itisimportanttobealertto

thepossibilityofamajorbloodsugardropandtoadjustyoureatingschedule,

medicationuse,andexerciseaccordingly.

Occasionally,theoppositecanoccur:Youmayfindthatyourbloodsugaris

temporarilyhigherafterexercisethanitwasbefore.

AresearchteambasedinFloridatrackedbloodglucoseinchildrenwithtype

1diabetesastheywalkedonatreadmillinfour15-minutebouts,with5-minute

restperiodsinbetween.Theiraveragebloodglucosewas159mg/dlwhenthey

started,andit fellto 112 mg/dlafterward.At leastone-quarter of thechildren

became hypoglycemic during or right after the exercise. They were also more

likelytobehypoglycemicduringthefollowingnight.

Exercisecanreduceyourbloodsugarsurprisinglyquickly.Ofcourse,ifyou

eattoomuchinanefforttopreventhypoglycemia,yourbloodsugarcangotoo

high.

For these reasons, it is important to speak with your caregiver about your

medication,diet,andexerciseprogramtomakesureyouarereadyforexercise,

thenmakewhateveradjustmentsareneededforsafety.

GETTINGSTARTED

Okay. Your doctor has given you the green light, you have rustled up some

friends,andyouarereadytobegin.

If you were imagining that I would push you into hours of jogging and

weight lifting and harangue you with exhortations about “no pain, no gain”—

well,pushthosethoughtsaside.Thegoalistoenjoyexercise—somuchsothatit

becomespartofyourlife.

Foraerobicexercise,Isuggeststartingwithahalf-hourbriskwalk5daysa

week, assuming that you have no health-related exercise restrictions. If you

prefer,youcanexercisethreetimesperweek,eithertakingbrisk1-hourwalksor

doingmorevigoroushalf-hourworkouts.Youcanalsobreakupthose30-minute

walks into 10- or 15-minute mini-workouts if you like. Do not allow yourself

morethan2sedentarydaysinarow.Thebenefitsofwalkingarenotasgreatas

thoseofamorevigorousexerciseprogram,butitisagoodplacetostart.

Theimportantthingistofindatimethatworksforyou.

It is a good idea to put exercise on your schedule, as if it were an

appointmentwithyourself,andtoincludesomeoneelseinyourplans.

A pedometer will help you keep track of your progress. In our research

studies, we use an Omron pedometer to track the total number of steps

participantstakeeachdayaswellasthenumberof“aerobicsteps”(stepstaken

as partof acontinuous walk ofat least 10minutes). Theparticipants canalso

program in their stride length to track mileage and even estimate their calorie

burn.Takenoteofhowmany(orhowfew!)stepsyoutakeinanormalday,then

graduallyincreasethem.Forreference,10,000stepsormoreisavigorousday

for a healthy person, but you may not have the strength or stamina to do that

many.Donotpushbeyondyourdoctor’srecommendedlimits.

Apodiatristornursespecializingindiabetes(certifieddiabeteseducator,or

CDE)willhelpyoutakecareofyourfeet.Thisisimportantsinceexercisecan

sometimescausefootinjuriesoraggravateanexistinginjury.Itissurprisinghow

oftenpeopleareunawareofgraduallyworseningfootsores.

Yourdoctorwillhelpyougaugeyourimprovementandcanadviseyouabout

increasing your exercise intensity. As your endurance improves, you will find

that your energy just keeps increasing, and your weight and blood sugar stay

underbettercontrol.

What’sYourPleasure?

Takingaregularwalkisagreatwaytostartexercising.Whenyouarereadyto

addotheractivities,thinkaboutwhichonesyoumightenjoy.

• Aerobicsclassescanbefun,social,andsometimesintense.

• Dancingiswonderfulexercise,withbettermusicthanmostaerobicsclasses.

• Tennis,eithersinglesordoubles,canbeagreatworkout.

• Many health clubs organize racquetball or handball lessons and

competitions.

• Golfcanbegreatexerciseifyouwalkthecourse.

• Local running clubs often organize training groups for people working

toward5-K,10-K,andhalf-andfull-marathonraces.

For resistance and flexibility exercises, I suggest that you work with a

personaltrainer,bothforsafetyreasonsandtoindividualizeyourprogramusing

the rightequipment. Professional athletesare not theonly ones with accessto

professionalfitnessexpertise;youcanhaveit,too.Apersonaltrainercanhelp

youplanafullprogram,notonlyforaerobicsbutalsoforstrengthtrainingand

flexibility.

mosthealthclubshavetrainersonstaffandmayevenofferafreesessionas

anincentivetojoin.Whynottakeadvantageofit?Ifyoudonotplanonjoining

agym,justmakeanappointmentforasingleexercisecounselingsessionsoyou

cangetaprogramthatisrightforyou.Thenscheduleafollow-up.

NoBlame,NoShame

Withexercise,justaswithdiet,mostpeoplearenotyetwheretheywouldliketo

be.Guiltandblamecomeintothepicturewhenwearesedentary,justastheydo

when we are not eating well. Sometimes family members try to scold us into

exercising, and sometimes doctors try the same approach. But all their

moralizing is nothing compared to the guilt-laden punishment we heap on

ourselves,asifnotexercisingwereatremendousmoralfailing.

Ifthatiswhereyouare,letmeencourageyoutosetguiltandblameaside.

Justletitallgo.Tellyourguilt-inducingfriendsthatupuntilnow,youhavebeen

illustrating Newton’s first law of motion. Now, however, you are about to get

intogearandexplorethesecondpartofthatprinciple.

Thesameappliesifyouhappentofalloffthewagon.Let’ssayyouhavelet

yourexerciseregimenlapseforabit—maybeevenaverylongbit.Donotwaste

yourtimefeelingbadaboutit;ithappenstoeverybody.Justdustyourselfoffand

getbackon.

Whenexerciseisfunandyourfriendsorfamilyarepartofit—andwhenyou

startatalevelthat’srightforyouandkeepitregular—youhavetheformulafor

success.

PART3

CompleteHealth

CHAPTER12

AHealthyHeart

Managing or reversing the effects of diabetes means more than getting your

bloodsugarundercontrol.Italsomeansregainingyourhealthasmuchasyou

possiblycan,andsafeguardingit.

Ifyouhavebeeninpoorhealth—orifdiabeteshasattackedyourheart,eyes,

kidneys,andnerves—revampingyourdietcanhaveadramaticpositiveeffecton

yourwell-being.Inthischapterandthenext,wewilllookathowtokeepyour

heart—andtherestofyou—healthy.

TAKINGRISKSERIOUSLY

You probably already have a good idea of your risk of heart problems. Your

doctor has sized up your cholesterol level and blood pressure, and you know

your family history. You may be on medications to control cholesterol or

strengthenyourheart.

The next step is to review what you need to know about risks, and more

important, to see what you can do to prevent heart disease and, if necessary,

reversethediseaseprocess.

In evaluating your risk of developingheartproblems, doctors look at your

age, family history, smoking habits, weight, cholesterol level, blood pressure,

andotherfactors.Ibelieve,however,thatitisprudenttoactasifyouareatrisk

evenifnoneofthesefactorsapplytoyou.Hereiswhy:MostpeopleinNorth

AmericaandEuropehave alreadydevelopedarteryblockages—thebeginnings

of heart disease—by the time they reach early adulthood. Having diabetes

increasesthatrisk.Ratherthan wondering,“Am Iatrisk?”itissafe tosimply

assumethatyouare—andtotakeactiontoprotectyourself.

Some evidence suggests that your heart is assaulted especially hard by

smoking, high blood pressure, and high cholesterol levels, while your small

bloodvessels,suchasthoseinyoureyesandkidneys,areespeciallysensitiveto

highbloodglucoselevels.Thatisprobablytrue,althoughalloftheseriskfactors

matterforbothtypesofcomplications.

SIZINGUPTHEENEMY

let’s take a minute to understand the dragons we are slaying, starting with

cholesterol.

Yourbodyusescholesterolinthesamewayafactorymightusepetroleum.

Cholesterolisarawmaterial,andyourbodymakesmanythingsfromit.Believe

it or not, cholesterol is used to make certain hormones, including testosterone

andestrogen.Itisalsoinsertedintothethincellmembranesthatsurroundeach

cellinyourbody,anditactsasakindofgluetoholdthemembranestogether.

Withoutit,youwouldcollapseintoagelatinousheap.

Justasrefineriessendtrucksfilledwithpetroleumtofactoriestobeturned

into everything from plastic to petroleum jelly, your liver sends particles

containingcholesterolintoyourbloodstreamforyourcellstouse.

Imagine what would happen if a refinery flooded the roads with tankers,

sendingoutfarmoresupplythanwasneeded.Dayafterday,moreandmoreoil

truckswouldcloguptheroadways.Somemighthaveaccidents,spillingcargo

andcreatinghavoc.

Cholesterol presents the same problem. When too many particles of

cholesterol pass through your bloodstream, they create a different kind of

congestion.

The circulating particles can easily become damaged. When they do, they

sparkthe formation ofraised bumpscalled plaques,which are verymuch like

smallscarsonyourarterywalls.

Now, this is dangerous, because plaques are fragile. They can crack or

rupture,andwhenthathappens,thebloodaroundtheplaquestartstoclot.The

growingclotcanfillthearterylikeacorkandstopblood-flow.Ifthathappensin

anarterythatcarriesbloodtotheheart,aportionofheartmusclewilldie.That’s

aheartattack,whichdoctorscallamyocardialinfarction.

Thesolutiontotheproblemistoreducethenumberofcholesterolparticles

circulating in the bloodstream. Luckily, we know how to do that. Although

previousdiets had onlya modestability tolower cholesterol,the diet changes

describedwithinthepagesofthisbookaredramaticallyeffective.

IsItMyGenes?

Rickwas45whenhecametoourofficelookingforhelp.Hewasnotterriblyoptimisticthata

dietchangecouldreallyhelphim.Hisfatherhadhaddiabetesandheartdisease,andhisown

cholesterolhadbeenhighforyears.Previousdietshadlethimdown.Afewyearsearlier,his

doctorhadsuggestedlimitingredmeatandeatingmorefishandchicken,butthechangehad

hadnoperceptibleeffect.“Imusthaveageneticproblem,”hesaid.

Itmaywellbethatgenesplayedabigroleinhisproblem,Itoldhim.Butwewouldnotknow

that until we made a more serious effortto change his eating habits—one that went beyond

whathehadtriedbefore.

Iexplainedtohimwhatyouarereadinginthischapter.Hedecidedtogiveitatry.(Hisstory

continuesinthebox“JumpingIntoOatmeal.”)

REVERSINGHEARTDISEASE

Themostfamousprogramusingdietandlifestylechangestotacklecholesterol

andreverseheartdiseasewasdevelopedbyDeanornish,MD,atthePreventive

MedicineResearchInstituteinSausalito,California.

Dr.OrnishisaHarvard-trainedphysicianwhomademedicalhistoryin1990

byshowingthatacombinationofdietandotherlifestylechangescouldactually

reverse artery blockages. His findings were published in the Journal of the

AmericanMedicalAssociation,Lancet,andotherprestigiousjournals.

Inhis landmarkstudy,Dr. Ornishrecruitedheart patientsfromhospitalsin

the San Francisco area and divided them into two groups. Participants in one

group—the control group—were asked to follow their regular doctors’ advice

aboutdietandothertreatments.Generallyspeaking,thatmeantadietfavoring

chickenandfishratherthanredmeat,cuttingbackonfat,andusingmedications

asneeded.

The other group—the experimental group—was given a very different

regimen.Theydidnotusecholesterol-loweringdrugsatall.Instead,theybegan

averyspecialdiet.First,becausecholesterolisfoundinanimalproducts(meat,

dairy products, and eggs), Dr. Ornish chose a vegetarian diet for the study.

Remember, grains, beans, vegetables, fruits—in fact,all plant-derived foods—

areessentiallycholesterol-free.

Thesefoodsarealsofreeofanimalfat,whichisevenmoreimportant.Justto

clarify,cholesterolandfataretwodifferentthings.Cholesterolisamicroscopic

ingredient in cell membranes, as described above, and is present in all animal

cells.

Fatisdifferent.Itisthewhite stripina cutofroast beef,theyellow layer

under chicken skin, and the greasy residue left on your fingers if you touch a

salmonfillet.Youcaneasilyseeandfeelanimalfat.Whenyoueatit,yourbody

makescholesterol.

I learned about animal fat as a child growing up in North Dakota. Some

mornings,mymothercookedbaconformyfoursiblingsandme.Whenitwas

done,sheputthehotstripsonpapertowelstodrain.Shethencarefullypicked

upthefryingpanandpouredthehotgreaseintoajartosaveit.Now,shedidnot

storethejarofbacongreaseintherefrigerator;shesimplyputitinthecupboard.

Sheknew thatasitcooled, itwouldturn intoawaxy solid.Thenext day, she

spoonedsomeofthebacongreaseintoapanandfriedeggsinit.Withthatsort

ofdiet,itisperhapsremarkablethatanyofherchildrenlivedtoadulthood,but

thatisthewayweateuntilwelearnedbetter.

The fact that bacon grease is solid at room temperature is a sign that itis

loadedwithsaturatedfat,whichyoucanthinkofas“bad”fat,becauseitraises

yourcholesterollevel.

Allfatsaremixtures.Beeffat,forexample,isabouthalfsaturatedfat,with

the rest being a mixture of various unsaturated fats. Chicken fat is about 30

percent saturated fat. Fish vary from about 15 to 30 percent saturated fat.

Vegetable oils are much lower in saturated fat, except for the tropical oils:

Coconut,palm,andpalmkerneloilareallhighinsaturatedfat.

Some food companies alter vegetable oils through a process called

hydrogenation, which makes them similar to saturated fats. The resulting fats,

calledtrans fatsor partiallyhydrogenated fats,are solidand have along shelf

life. Unfortunately, their effect on your cholesterol level is similar to that of

butterorlard.Theyaresometimesusedinrestaurantfryersandinsnackfoods.

Whenyou seethewords partiallyhydrogenated vegetableoil on a food label,

it’sagoodideatomovealongtoahealthierchoice.

YoucanseewhyDr.Ornishdecidedtouseavegetariandietinaprogramof

healthy lifestyle changes. Plant foods have essentially no cholesterol and no

animalfat.Healsokeptvegetableoilstoaminimum.

The results were remarkable. Among the vegetarians, chest pain rapidly

melted away. The average person’s LDL (“bad”) cholesterol fell by about 40

percent. After a year, each participant had an angiogram—a special x-ray that

shows blockages in the arteries of the heart—and Dr. Ornish compared the

resultswiththoseofthesamekindoftestdoneatthebeginningofthestudy.The

resultswereamazing:Theblockages inthe coronaryarteries—thearteriesthat

nourish the heart muscle itself—were actually starting to shrink. The arteries

wereopeningagain.Theeffectwassopronouncedthatthedifferencecouldbe

clearlyseenontheangiogramsof82percentofpatientsafterthefirstyear—all

with no heart bypasses, no angioplasties, and not even cholesterol-lowering

drugs.

WAKEUPANDSMELLTHECHOLESTEROL

Bynowyouareprobablyyawning,sayingyoualreadyknowthatcholesteroland

saturatedfatarebadandthatwe’resupposedtocutdownonthem.“Beenthere,

donethat,”yousay.

Well,thatisexactlytheproblem.Foryears,healthauthoritieshavesuggested

that people “cut down” on foods containing cholesterol and animal fat. Many

peoplehavechosen“leaner”cutsofbeefandfavoredchickenandfish,butthey

havegottenverylittleinthewayofresults.Mostpeoplefindthatdespitethese

dietchanges,theircholesterollevelsbarelybudgeatall,andmanyhavedecided

that diet changes are a waste of time. They conclude that their problems are

geneticandgiveupontheirdiets.

It turns out that a switch from red meat to white meat is just not good

enough. And here’s why: All meats—even “lean” meats—contain cholesterol,

rangingfromabout10milligramsineveryounceoftunatoabout50milligrams

perounceofshrimp.Chickenandbeefareinbetween,withabout25milligrams

per ounce. And yes, cholesterol in foods does pass into your bloodstream.

Despite the egg industry’s efforts to convince scientists and the public that

“cholesterolinfoodsdoesnotaffecthowmuchcholesterolisinyourblood,”the

factis thatcholesterolinfoodsdoes indeedraise bloodcholesterol.Red meat,

poultry,andfish—eventhe“leaner”cuts—alsocontainasignificantamountof

fat.Andsaturatedfatcausesyourbodytomakecholesterol.

Incontrast,ofcourse,thereisnocholesteroloranimalfatinanyfoodfrom

plants.That goesfor everyfruit andvegetable; everybean; everygrain;every

varietyofrice,pasta,andpotato;andeverythingmadefromthem.

Thus,ifyouweretotrytoloweryourcholesterolbysimplyswitchingfrom

beef to chicken and fish, you would have one arm tied behind your back. As

showninclinicaltests,thecholesterol-loweringeffectofaswitchfromredmeat

towhitemeatisminimal—onlyabouthalftheeffectofaplant-baseddiet.Most

people who follow such diets have no measurable improvement within their

arteries,either—onaverage,theirarteryblockagescontinuetogetworseastime

goesby.

WHYDIDN’TANYONETELLME?

When Dr. Ornish’s findings were published, most medical authorities were

willingtobelievehisprogramwasaveryhealthfulregimen.Butmanyfeltthe

programwassoausterethatfewpeoplecouldactuallyfollowit.Ihavestudied

that issue in some detail, however, and have come to a completely different

conclusion.Thedietisnotterriblyaustere.Infact,itstacksupwellagainstany

otherdietadoctormightprescribe.Letmedescribemyownexperience.

When I was growing up in cattle country, my family ate pretty much the

samethingseveryday:roastbeef,bakedpotatoes,andcorn—exceptforspecial

occasions,whenweateroastbeef,bakedpotatoes,andpeas.

Inmedicalschool,Idecidedtochangemydiet.Atfirst,Itriedpasta,making

asaucefromfreshtomatoes,basil,andspices.ThenIdiscoveredthatjustbelow

the beef, poultry, and fish choices, Chinese restaurant menus feature many

deliciousvegetabledishes,asdoMexicanrestaurants.Japaneserestaurantsserve

delicious miso soup, salads, and vegetable sushi. Middle Eastern cuisine is

simplebutdelicious,withhummus,falafel,couscous,andotherdelights.Thai,

Indian,Ethiopian—allthesecuisinesofferendlessvegetarianchoices.Compared

tothoseelegantmeals,myNorthDakotaroastbeef,bakedpotato,andcornno

longerseemedlikethepinnacleoftheculinaryart.Tome,aplant-baseddietwas

aworldofnewtastesandwasanythingbutaustere.

WhenI firstlearned aboutthe workof Dr. Ornishin thelate 1980s,I was

workingatthepsychiatryclinicatGeorgeWashingtonUniversity.Itelephoned

him and suggested that we study the acceptability of his diet. I flew to San

Francisco and interviewed each of the participants in his heart study.

 I asked

howwelltheylikedthefoodstheyate,howmucheffortwasrequiredtoprepare

them, whattheir family members thought,and what they planned todo in the

future.

Ifoundthatthevegetariangroupdidgrumbleabitatfirst.Theyhadtolearn

aboutsomenewfoodsandmastersomenewcookingtricks.Onaverage,ittook

about 4 weeks before the diet really became second nature to them. But they

adapted well, partly because they saw such dramatic results. Their cholesterol

levelsplummeted,theirchestpaindisappeared,andtheirheartdiseasereversed.

Theaverageparticipantlost,believeitornot,22poundsduringthefirstyear.

2,3

Theycametolovethefoodstheyate.

I vividly remember one participant’s reaction. He was angry—angry that

previousdoctors wereeagerto prescribepotentiallydangerousdrugs andeven

operateonhim,charginghimenormousamountsofmoney,anddidnotbotherto

evenmentionthepowerofdietchanges.Overall,theparticipantsnotonlyfound

theirdietsacceptable,theyfeltitwouldbewrongfordoctorsnottogivepatients

thiskindofchoice.

Now,itdidnotsurprisemethatthevegetariandiettookalittlegettingused

to,orthatthepatientssooncametoloveit.Whatsurprisedmewasthereaction

ofthecontrolgroup—thegroupthatwasnotaskedtoadoptthevegetariandiet.

They grumbled, too. Some said their diet was nothing but chicken and fish,

chicken and fish, chicken and fish, night after night. All the pleasures of life

were gone, some said. And they had nothing to show for it. Many were still

dealing with chest pain, trying to control their cholesterol levels with

medication,andfightingalosingbattle.

Having repeatedly studied how people react to different diets, I am

convinced that a vegan diet is actually easier to follow than most other diets.

Thisispartlybecauseofitssimplicity.Likequittingsmokingorfreeingyourself

fromanyotherhabit,settingasideunhealthyfoodsiseasierthanteasingyourself

withsmallamountsofthemdayafterday.Andthediet’sbenefitsareusuallyso

rewardingthatyouwanttostickwithit.

Afewyearslater,Ireviewedeverypublishedresearchstudyinwhichheart

patientswereaskedtochangetheirdiet,withresearcherstrackingtheirsuccess

orfailure.

Atthetime,theprevailingwisdomwasthatdoctorsshouldnotpush

theirpatientstoohardtomakedietchangesbecausethepatientswerelikelyto

justthrowuptheirhandsandgiveup.ButIfoundjusttheopposite.Incontrolled

studies,whenresearchersaskedpatientstomakesmalldietchanges,theyinfact

achieved only small changes. When researchers encouraged their study

participants to make bigger diet changes, most participants actually did make

them,andtheygotbetterresults.Youcandoit,too.Yourheartdeservesthevery

best.

AIMINGTOBEHEARTATTACK–PROOF

let’sleaveDr.Ornish’sCaliforniaresearchcenterandtakeashorttriptoOhioto

meetAnthonyYen.HegrewupinChina,wherehisfamilymembersroutinely

lived to a ripe old age. For them, heart disease, weight problems, diabetes,

cancer,andhighbloodpressurewerevirtuallyunheardof.Theydinedonrice,

noodles,andvegetabledishesofvariouskindsandusedmeatasnomorethana

flavoring,thewaysomemightusebitsofonion,garlic,orpinenuts.

In1949, asa youngman,Anthony movedto theUnitedStates andslowly

gaveuphistraditionalChinesedietinfavorofanAmericanone.Astheyears

wentby,hegraduallygainedweight,likemanyofhisAmericanfriends,andhe

started to develop heart problems, which steadily worsened. Ultimately, he

neededsurgery—aquintupleheartbypass.

Then he was lucky enough to join a program for heart patients run by a

surgeon at the Cleveland Clinic. Caldwell Esselstyn Jr., MD, aimed to get

cholesterol levels so low that heart disease would stop in its tracks. He

prescribed a vegetarian diet without dairy products or added oils. He showed

patientshowto cookandeven occasionallyhostedgroup dinnersthatfeatured

home-cookedfoods. Headded medicationsonlyif apatient’s cholesterol level

didnotfallbelow150mg/dlwithdietalone.

Theprogramworked.Dr.Esselstyn’spatientsbecamepracticallybulletproof.

Althoughtheywereinbadshapewhentheyarrived,noonewhoadheredtothe

program hadany sort of recurringheart problem.

 Anthony’s cholesterol level

improveddramatically.Helostweightandfeltbetterthanhehadinyears.

Intheensuingyears,Dr.EsselstyncalledAmericancardiologiststogetherfor

theSummitonCholesterolandCoronaryDisease.Heputforwardhisbeliefthat

physiciansneedtopromotehealthierdiets.Ifdoctorscontinuetoprescribeonly

modestly effective diets, he said, their patients will be stuck with endless

prescriptions,operatingroomswillremainbusywithangioplastiesandcoronary

bypasssurgeries,andmedicalcostswillcontinuetosoar.

Dr.Esselstynwas right,asAnthony Yen, hisotherpatients,and agrowing

numberofphysicianscanattest.

SPECIAL-EFFECTFOODS

By now, you know which foods to avoid. By skipping animal products and

added oils, you will sidestep cholesterol and the fat that can drive cholesterol

levelsup.Ofcourse,youwanttoavoidthesefoodsanywayinordertoimprove

diabetes.

Therearefoodsyoumightwanttoaddtoyourdiet,though,becausetheycan

actuallyloweryourcholesterolorprotectagainstthedamagethatcholesterolcan

cause.

• Oats, beans, and barley contain soluble fiber that reduces cholesterol

levels.Youhavenodoubtheardthatoatmealandotheroatcerealshavethis

effect, and they have become popular for exactly that reason. But do not

forget the cholesterol-lowering power of the humble bean, which also

containssolublefiber.Eatinga servingof beansevery daycuts cholesterol

levelssignificantly.Solublefiberisalsofoundinmanyvegetablesandfruits.

• Soyproductshaveaspecialcholesterol-loweringeffect.Asidefromthefact

that they have no cholesterol or animal fat, there is something about soy

proteinthatbringsdowncholesterolabitfurther.Ifyourburgerismadeof

soybeansinstead ofbeef, youwillnot onlyskip beef’s cholesteroland fat,

youwillalsogetanextracholesterol-loweringbenefit.

• Certain nuts, such as almonds and walnuts, lower cholesterol, too. Yes,

they are as high in fat as other nuts, but somehow they have an ability to

reducecholesterollevelsthathasnotbeenfullyexplained.Instudies,eating

3 ounces a day for 4 weeks has shown a measurable effect.

 I do not

recommendthatyoumakenutsaregularpartofyourdiet,however.Despite

theircholesterol-loweringeffect,theyaresofattythattheywillmakeweight

loss difficult and may interfere with your efforts to improve insulin

sensitivity.

• Some margarines incorporate natural plant stanols or sterols that work

almost like drugs, blocking the absorption of cholesterol from the small

intestine.BenecolLightspread,forexample,containsplantstanolsderived

frompinetreesmixedintoaspreadmadewithcanolaandsoybeanoils(see

benecol.com).Youcanuseitinbakingandfryingifyoulike.Itisnotalow-

calorieor low-fat spread,though; 1 tablespoonhas about50 calories. Like

nuts,margarinescaninterferewithyourweight-lossefforts.

• Fruitsandvegetablesarenotonlycholesterolfreeandverylowinfat;their

beta-carotene, vitamin C, and vitamin E can actually reduce the damaging

effectsofcholesterolinyourblood.Here’swhy.

Ascholesterolparticlesglidealonginyourbloodstream,thosethatenter

arterywallsandcauseplaquebuilduparetheonesthathavebecomeslightly

damaged, or oxidized. Beta-carotene, vitamin c, and vitamin E actually

protectthecholesterolparticlesfromdamagesotheygoontheirmerryway

withoutharmingyou.

Youwillfindhugeamountsofbeta-caroteneinorangevegetables,such

as carrots, sweet potatoes, and pumpkins, but there is also plenty in green

leafy vegetables. Vitamin C is in citrus fruits, of course, but also in many

other fruits and vegetables. And whole grains, vegetables, and beans are

healthfulsourcesofvitaminE.

At the University of Toronto, Dr. David Jenkins took this approach to its

ultimateconclusion.Hereasonedthatifavegandiet(thatis,onewithnomeat,

dairyproducts,oreggs)lowerscholesterollevels;ifsolublefiber,suchasthatin

oat bran, lowers cholesterol; if certain nuts lower cholesterol; if soy products

lowercholesterol;andifplantsterolslowercholesterol,thenwhatwouldhappen

ifheprescribedthemallatthesametime?

He devised what he called a portfolio Diet, which included all of these

elements, and found that the combination led to a 29.6 percent drop in LDL

cholesterol in just 4 weeks, which was similar to the effect of cholesterol-

loweringdrugs.

CONTROLLINGCHOLESTEROLSTEPBYSTEP

Let’ssummarizewhatresearchtellsusabouttheidealcholesterol-loweringdiet.

Herearethekeys.

1.Skipanimalproducts. Youwillwantto avoidmeat(thatmeansnored

meat, nochicken, and nofish),dairy products, andeggs. Avoid them entirely,

and you will eliminate all the animal fat and cholesterol from your diet. You

alreadyknowthisisimportantfordiabetes,anditisjustasimportantforyour

heart.

2.Keepvegetableoilstoaminimum.Totrimtheoilfromyourdiet,skip

theoilydressings,friedfoods,andfoodspreparedwithextraoil.Readthelabels

onpackagedfoods.Ifyouspotanimalproductsorpartiallyhydrogenatedoilsin

theingredientlist,youwillwanttoavoidthatfood.Andiftherearemorethan2

to3gramsoffatinaserving,skipit.

3. Add special-effect foods. The best of these are oats, beans, and soy

products.Theyarefillingbutmodestincalories,andtheyreallydobringyour

cholesteroldown.Itiseasytoaddspecial-effectfoodstoyourroutine.

Oats: Start your day with a bowl of old-fashioned oatmeal. Top it with

cinnamonifyoulike,butskipthemilkandsugarorusesoymilk.

Beans:Likeoats,beansarehighinsolublefiber,whichlowerscholesterol.

Bakedbeans,blackbeanswithsalsa,pintobeanswrappedinatortilla—all

are loaded with soluble fiber, protein, and all-around good nutrition. The

humblebeanhasevenbecomequitechic,withsomegrowersspecializingin

beautifullycolorfulheirloomvarieties.

Soy: It is easy to bring soy milk into your routine. You will also want to

learn about the many other forms of soy: low-fat tofu, tempeh, and many

others.Somepeopleareabittentativeabouttofuuntiltheytasteitproperly

prepared,thentheycometoloveit.Forallsoyproducts,readthelabelsand

choosethoselowestinfat.

Withthesechanges,mostpeoplecanexpecttoseemajorresults.Dietsthat

eliminatecholesterolandanimalfat(vegandiets),keepoilslow,andusespecial-

effectfoodstypicallyachieveabigreductionin“bad”cholesterol.

4. If you are overweight, follow the weight-loss guidelines described in

Chapter6.Eachpoundyoulosecutsyourtotalcholesterolslightly.

Theeffectis

gradualbutimportant.

5.Exercise.Whenyourdoctorgivesyouthegreenlighttoexercise,youwill

finditenormouslyhelpful.Exercisewillnotloweryourtotalcholesterol,butit

willincreaseHDLcholesterol,andthatmayimproveyouroverallhealthprofile.

Regularexercise(takingabrisk30-minutewalkfivetimesaweekora1-hour

walk three times a week) also helps keep your blood pressure under control.

Work with yourdoctor to set exercisegoalsbased on your current health(see

Chapter11).

JumpingIntoOatmeal

Rick,whomyoumetearlier,didverywellwithhisdietchangesdespitehisinitialreservations.

Helearnedhowtomakeaquickandheartyvegetablesoupfromadriedsoupmixtowhichhe

addedtomatoes,cucumbers,sweetpotatoes,andwhateverothervegetableshehadonhand.

Heoftencookedpastaandusuallyusedmarinarasaucefromajarforconvenience.Healso

includedplentyofsaladsandcookedvegetables.Eatingoutwasachallengeforhimuntilhe

discoveredthatinternational(Italian,Chinese,Japanese,Mexican,Thai,etc.)restaurantshad

plenty of options. Speaking up helped, too—most restaurants gladly made him a vegetable

platewhen he asked forit. He figured outwhich fast-food restaurants had veggie burgersor

saladbarsandwherehecouldgetarespectablebeanburrito.

Hetookashinetowhathecalledfakemeats—bologna,ham,andotherdelislicesmadeof

soy protein—which he used in sandwiches with sliced tomato, lettuce, and Dijon mustard.

Sometimeshehadasimplemealofbeansandriceorapackagedricedish(curriedrice,rice

pilaf, etc.). He also became quite fond of couscous. For breakfast, he jumped into oatmeal,

figurativelyspeaking,andkeptbananasandotherfruitsonhandbothathomeandatwork.

Whilehefoundthedietsurprisinglyeasy,heranintoastumblingblockatthebeginning.He

servedhimselfmodestportionsandresistedgoingbackforseconds.Asaresult,heoftenfelt

hungry.Thefix:Hesimplyatemore.Onanotheroccasion,hetookmyadvicetoeatbeansabit

toofarandhadanepisodeofgastricdistress.Hecutbackonhisbeanservingsizesforabit

andwasfine.

Hiswifejoinedhiminadoptingavegandiet.Intheprocess,shelostasubstantialamountof

weightandhadmoreenergythanshehadhadinyears.

BythetimeRickcameinforhisfollow-upbloodtest,hehadtotallyadaptedtothediet,and

hewasthrilledwiththeresults.In3months,hischolesterolhaddroppedfrom210to145,with

an LDLof well below 100. And this was the same man who had started out saying what he

reallyneededwasdifferentgenes.“Youknow,thisisn’tadiet,”hesaid.“Thisisawayofliving,

anditjustfeelsrighttome.I’mnevergoingbacktothewayIusedtoeat.Thisisit.”

SIZINGUPYOURPROGRESS

Itiseasytoseeiftheprogramisworking.Followitcarefully,andafterabout8

weeks, ask your doctor to check your cholesterol level. If you have not quite

reachedthegoalsyousetforyourself,takeacloselookatwhatyouhavebeen

eating. How well have you followed the program? If you really did follow it

carefully and your cholesterol failed to budge, you are probably one of those

uncommonindividualswhosegenesreallyaredrivinguptheircholesterollevels.

If diet alone proves insufficient, follow your doctor’s advice, which may

includecholesterol-loweringmedications.Somedoctorsbelievethatmedications

havevalueeven whencholesterollevelsarenormal. Researchisunder wayto

testthispossibility.

WHATABOUT“GOOD”CHOLESTEROL?

The cholesterol in high-density lipoprotein (HDL) particles is called “good”

cholesterolforonlyonereason:Itisonthewayoutofyourbody.HDLparticles

scour your artery walls, picking up cholesterol and eliminating it, like tiny

sanitationtruckscarryingawaygarbage.

When people begin low-fat vegan diets, their HDL levels sometimes fall

slightly.Butthatisnotareasontoworry—yourLDL(“bad”)cholesterollevelis

likely to fall much more. In fact, some people say that, since you have less

“garbage”inyourbloodstream(thatis,lessLDLcholesterol),youdon’tneedso

many“garbagetrucks”(thatis,HDLcholesterol)tohaulitaway.

REDUCINGTRIGLYCERIDES

Triglycerides is a technical term for fat in the bloodstream.

 lowering

triglyceridesis agood idea,as itwillreduce yourrisk ofheart problems.It is

usually easy to do. A low-fat plant-based diet is a good start. But take one

additionalstep:avoidsugar,whitebread products,and otherhigh-GI foods,as

discussed in Chapter4. These foods seem to raise triglycerides, while low-GI

foodsthatarerichinfiberseemtolowerthem.Youwillprobablyseeabigdrop

inyourtriglycerides.

ONESOLUTIONTOMANYPROBLEMS

If you have been following along, you have probably come to this happy

conclusion on your own: You do not need one diet for diabetes, another for

cholesterol control, and a third one for weight loss. A diet that skips animal

products,keepsvegetableoilslow,andfavorshigh-fiber,low-GIfoodstackles

alltheseproblemsatthesametime.

Justas a dropin cholesterolis goodfor yourheart, adrop in A1Cis, too.

Peoplewhokeeptheirglucoseundergoodcontrolhavefewerheartproblemsas

theyearsgoby.

Thesamedietchangesalsohelpcontrolyourbloodpressure,partlybecause

theycancauseyoutoloseweight,andasyourweightfalls,sodoesyourblood

pressure.Buttheeffectofvegetariandietsonbloodpressuregoesbeyondtheir

effectonweight.Plant-baseddietsarerichinpotassium,whichseemstoreduce

bloodpressure.Theabsenceofanimalfatalsoreducesbloodviscosity(thatis,

blood is less “thick”—less like grease and more like water) so it flows more

easilythroughthebloodvessels.

For many people, the effect of diet changes rivals or exceeds that of

medications.If,forwhateverreason,yourcholesterol,bloodpressure,orblood

sugar doesnot come undergoodcontrol despite yourbest efforts,your doctor

willrightlytalkwithyouaboutmedicationstotakeupwheredietleavesoff.

Ifyouarewonderingwherethetermsaturatedfatcamefrom,it’sactuallyverylogical.Ifyoucouldlook

atafatmoleculeunderapowerfulmicroscope,itwouldlooklikealongchainofcarbonatoms,with

perhaps18or20atomsjoinedinaline.Attachedtothecarbonchainarehydrogenatoms.Ifthechainis

completelycovered(i.e.,saturated)withhydrogenatoms,thefatbecomesawaxysolidandiscalleda

saturatedfat.If,however,hydrogenatomsareabsentatseveralspotsonthefatchain,thefatiscalled

polyunsaturated.Polyunsaturatedoilsareliquids.Andifjustonespotonthecarbonchainhasnohydrogen

atomsattached,thefatiscalledmonounsaturated.Oliveandcanolaoilsarerichinthissortoffat.Theyare

unusualinthattheyareliquidatroomtemperaturebutsolidintherefrigerator.Saturatedfatisthekindthat

pushesyourcholesterolupward.

Thewordtriglycerideisderivedfromthefactthatwhenyourbodytransportsfatmoleculesfromone

placetoanother,itgenerallyattachesthreefatmoleculestoaglycerinemolecule(hence,tri-glyceride)

beforesendingthemintothewateryenvironmentofthebloodstream.

CHAPTER13

HealthyNerves,Eyes,andKidneys

Selwynwas 58years oldwhen heheard wewere lookingfor volunteersfor a

research study. Originallyfrom Trinidad, he hadbeen diagnosed withdiabetes

almost 20 years earlier. The disease had taken a toll on his eyes, and he was

beingtreatedforglaucoma.

Healsohadterriblenervepain.Inthe18monthsbeforethestudybegan,the

paininhisfeethadgottenworseandworse.“Itwasexcruciating,”hesaid.“It

hurtfrom the calvesdown, especiallyonthe leftside. And itworsened asthe

dayworeon.BythetimeIgothomefromwork,Ijusthadtoputmyfeetup.At

night,thebottomsofmyfeethurtterribly,withburningandtingling.”

He had had several medical tests to search for a treatable cause, but his

doctorswereleftwithonlydiabetestoblameforhismisery.Despitethefactthat

heusedinsulintwiceaday,hisdiabeteswasnotundergoodcontrol.

He began doing stretching exercises, which seemed to ease the pain

somewhat.Whenourstudybegan,hestartedalow-fat,vegandiet.Itsuitedhis

tastesandhadaremarkableeffectonhisdiabetes.Atthebeginningofthestudy,

hisA1cwas9.1percent,buthisbloodsugarbegantofallsoonafterhemadethe

switch to our eating plan. Within a month, he began to have episodes of low

blood sugar, so his insulin doses were reduced. Despite the fact that he was

takinglessmedication,hisA1Catthe3-monthpointwasdownto7.7.Thatwas

abigimprovement,althoughhewasnotyetwhereheneededtobe.

However,hekeptimproving.Andabout6monthsintothestudy,something

remarkablehappened.“Inoticedadrasticchange.Ihadbeenintotalpain,but

thesymptomsstartedgoingaway,”hesaid.As timewenton, thingsgot better

and better. The pain became barely perceptible, and eventually—to his

amazement—itdisappearedaltogether.“I’mtotallynormal,”hesaid.“Ihaveno

painatallanymore.”

If a medication could deliver the result he achieved, it would be a very

popularoneindeed.“Thedifferencehasbeenlikenightanddayforme,”hesaid.

Ahealthfuldietdoesmuchmorethankeepyourbloodsugardown;ithelps

protectyourwholebody.Ifdiabetesragesoutofcontrol,itcannotonlydamage

yourheart,itcanalsoattackyournerves,youreyes,andyourkidneys.Thediet

youarenowbeginningwillhelpyouavoidtheseproblems.Inthischapter,we

willlookathowtokeepallyourbodypartsingoodworkingorder.

HEALTHYNERVES

Peoplewithdiabetesareatriskofnervedamage,whichcantaketwoforms.

Peripheral neuropathy, sometimes called sensorimotor neuropathy, is

damagetothenervesthatallowyoutofeelthingsortomoveyourmuscles.It

leadstotingling,pain,numbness,orweaknessinyourfeetorhands.Itpaysto

takethesesignsseriouslybecausealthoughitcangetbetter,itcanalsogetalot

worseifyouarenotcareful.

Reducedsensationinyourfeetcanleaveyouvulnerabletoinjuriesthatyou

cannotfeel.Itiseasytooverlookasmallcutorscrapewhenyoudonotfeelit.

Injuriescanalsobeslowtoheal,whichcansetyouupforafesteringinfection.

Diabetesisacommoncauseofamputation,somethingthatshouldneverhappen

withgoodcare.

Autonomic neuropathy is abnormalities in the nerves that control your

internalfunctions.It canleadto digestiveproblems,suchasnausea,vomiting,

constipation, or diarrhea. It can also cause problems with bladder control or

sexual function. Other symptoms include dizziness, faintness, increased or

decreasedsweating,visualdifficulties(e.g.,problemsadjustingtolightanddark

conditions),andlackofawarenessofthewarningsignsoflowbloodsugar.

SEEYOURDOCTOR

Sometimes nerve symptoms have nothing to do with diabetes. If you have

unexplainednumbness,pain,tingling,orothernervesymptoms,itisimportant

tosee your doctorto check forconditions thatcan be treated.For example,if

you are low in vitamin B

, you can have nerve pain that is indistinguishable

from the nerve symptoms of diabetes and can end up being permanent. Your

doctor willcheck your vitaminB

 bloodlevel and will helpyou get back on

track, if that is the issue. Nerves are also affected by thyroid conditions,

medications,infections,compression,andotherfactors.Soit’simportanttohave

agoodevaluation.

Ifthediagnosisisdiabeticneuropathy,thekeytopreventingandtreatingitis

to get your diabetes—particularly your blood glucose level—under control,

startingwithdietandexercise.Ifneuropathyhasaffectedyou,youwillwantto

rereadChapter4andfollowthedietguidelinestotheletter,aimingforthebest

possible glucose control under the guidance of your doctor. There are

medicationsthatcanhelpslightly,butformostpeople,dietandexercisearefar

morepowerful.
At California’s Weimar Institute of Health and Education, Milton Crane,
MD, asked 21 diabetes patients with peripheral neuropathy to do two things:
begin alow-fat, vegandietand takea daily 30-minutewalk. The effects were
rapidandverystrong:Within2weeks,legpainsstoppedcompletelyin17ofthe
participants,andtheremaining4hadpartialrelief.
1
Myownresearchteamcarriedthisresearchastepfurther.Weinvitedpeople
with neuropathy to see what a diet change alone could do for them—without
exercise.Notthat exerciseisbad.Just theopposite,it’svery healthful,butwe
wanted to isolate the effectof diet for scientific reasons, to see how powerful
foods could be. Using the diet steps that are now familiar to you (avoiding
animalproducts,minimizingtheuse ofoils,andfavoringlow-Glycemic-Index
foods), we found that, for many patients pain improved or simply went away,
andobjectivetestsofnervefunctionimproved,too.
2
SupplementsforTreatingNeuropathy
Researchershave testedthe effectsof thefollowing supplements.The verdicts
arenotyetinonthemastreatmentsfornervedamage,soI’mlistingthemhere
notasarecommendationbutsimplytomakeyouawareofthem.
Alpha-lipoic acid appears to improve neuropathy symptoms.
3
 In research
studies,adoseof600milligramstakenoncedailywaseffective.
Gamma-linolenic acid is an omega-6 fatty acid commonly sold in health
food stores. At doses of 480 milligrams per day, it appears to reduce
neuropathysymptoms.
4
Carnitine, in doses of 1,000 milligrams daily, appears to improve nerve
conditionandreducepaininpatientswithdiabeticneuropathy.
5
IfYouHaveNerveDamage
Ifthenervesofyourfeethavebeendamaged,itisimportantthatyougetregular
checkupsandprotect yourfeet.Ifyou havelostsome feeling,check yourfeet
dailyforanysignofinjuryorinfection,suchasrednessorswelling,andhaveit
treatedrightaway.Avoidwalkingbarefoot.Ifyouhavelostsomefeelinginyour
feet,youmaynotknowifyousteponsomethingthatbreakstheskin.Besure
yourshoes fitproperlyto avoidblisters, andbreakin newshoes slowly. Keep

yournailsingoodshape,anddonottrimthemshorterthantheendsofyourtoes.

Ifyourvisionispoororyouhavedifficultysafelytrimmingyournails,havea

podiatristexamineyourfeetandtrimyournails.

Needless to say, you will want to focus on more than just caring for your

feet. Fight back against neuropathy with a healthy diet—vegan, low-fat, and

low-GI.

HEALTHYEYES

Youreyesaredelicatecamerasthatcapturetheworldaroundyou,transmitting

itsdetailstoyourbraintoperceiveandremember.Inthesamewaythatacamera

is fragile, several parts of the eye are susceptible to damage. This is true for

anyone, but especially for people with diabetes. Protecting your eyes means

keepingyourbloodglucose,bloodpressure,andcholesterolundercontrol.

Threepartsoftheeyeareparticularlyvulnerable.First,pressurecanbuildup

in the front part of the eye—called the anterior chamber—and eventually

damage the retina and optic nerve. This is glaucoma. Second, a cataract can

compromise the lens’s clarity. Third, blood vessels in the retina can become

damaged.Let’slookatwhatwecandotopreventthisthree-prongedassault.

Glaucoma

There are several different types of glaucoma. Typically, increasing pressure

withintheeyepinchesthetinybloodvesselsintheretina,damagingitandthe

opticnerve.Highbloodpressureandhighglucoselevelsbothincreaseyourrisk

ofdevelopingglaucoma.Yourbestdefenseistogetbothundercontrol,usingthe

informationinthischapterandtherestofthisbook.Ifglaucomaiscaughtearly,

treatment(withprescriptioneyedrops)ishighlyeffective.

Glaucomacanbeginwithnosymptomsatall,soitisimportanttohaveeye

examinationsbyanophthalmologistatleastonceayear.

Cataracts

Ifthelensoftheeyelosesitsclarity,becomingmorelikewaxedpaperthanlike

aclearpaneofglass,adoctordiagnosesacataract.Youmayexperienceblurred

ordoublevision, difficulty withdistancevision,a haloeffectaround lights,or

excessiveglareinbrightsunlightorwhiledrivingatnight.

Whilecataractsurgeryhas advanceddramaticallyinrecent years,theideal

situation is to keep your original equipment in good working order. Luckily,

thereareseveralthingsyoucandotohelppreventcataracts.
First, it is important to avoid tobacco and to protect your eyes from harsh
sunlight.
Second, it pays to follow the same diet steps that apply to controlling
diabetes in general, as described in Chapter 4. That means avoiding animal
products, keeping oils to a minimum, and favoring low-GI foods. There is
evidencethatthesestepsreduceyourrisk.Specifically,peoplewhoavoidfatty
foodstendtohavelesscataractrisk.
6
Thesameappearstobetrueforpeoplewhoavoiddairyproducts.Generally
speaking,peoplewhosteerclearofdairyproductsappeartohavesignificantly
lessriskofdevelopingcataracts.
7
Theculprithereappearstobelactose,ormilk
sugar,ratherthanmilkfat.
Duringthedigestiveprocess,lactosereleasesasimplesugarcalledgalactose,
whichcanenterthelens.Infantswholacktheenzymesnecessarytobreakdown
galactosedevelopcataractswithinthefirstyearoflife.Therelationshipbetween
dairy products and cataracts is still being studied, but this is one more good
reasontoavoidthem.
Certain foods help protect the eyes. Particularly valuable are green leafy
vegetables such as broccoli, spinach, kale, collards, and mustard greens. They
are rich sources of certain antioxidants, called lutein and zeaxanthin, which
protectboththelensandtheretina.
8
FoodsrichinvitaminscandEmayhelp,
too.
9
 You will find plenty of vitamin c in oranges, bell peppers, cantaloupe,
strawberries, and kiwifruit. It also shows up in places you may not expect:
cruciferous vegetables—broccoli, Brussels sprouts, cauliflower, and kale—as
well as tomatoes and sweet potatoes. Healthy sources of vitamin E include
cookedspinach,soy milk,mangoes, andwheatgerm. Mostnutsand seedsare
particularlyrichinvitaminE,butbecareful,astheyarefattyandloadedwith
calories.Asmallhandfulhasabout5milligramsofvitaminE.
Finally, people who avoid alcohol have about 10 percent less cataract risk
thanotherpeople.Evenverymodestconsumption,abouttwodrinksperweek,is
linkedtoincreasedrisk.
10

Retinopathy

Theretina,locatedatthebackofyoureye,islikecamerafilm.Millionsoftiny

nervesintheretinapickupimagesandsendthemtothebrain.Alsolikefilm,

your retinas are fragile. They can be damaged by high blood sugar, blood

pressure, or cholesterol, leading to a condition called retinopathy, meaning

damagetotheretina.Theconditionoccursintwomainforms.

Nonproliferativeretinopathyoccurswhencapillariesballoonoutandleak

substances into the retina, leading to the formation of fatty deposits. The

condition is usually mild and needs no treatment, but it is essential that an

ophthalmologist check your eyes regularly to be sure that it does not become

moreserious.

Proliferativeretinopathy occurs when blood vessels are so damaged that

theybegintocloseoff.Whenthathappens,new,abnormalvesselsstarttoform

in the retina. The new vessels are fragile and prone to bleeding, leading to

scarringandsometimeseventoretinaldetachment.Ophthalmologistsuselaser

treatmentstotreattheabnormalvessels.

Most people with diabetes eventually develop at least a mild degree of

retinopathy. Thegoodnews isthatthere isa lotyoucan doto preventserious

problems.Goodbloodglucosecontrolprotectstheeyes,andbynowyouknow

how to go about attaining that. Keeping blood pressure and cholesterol down

helps,too.Thedietstepsabovewillgoalongwaytowardhelpingyoureachthat

goal.Ifdietaloneisinsufficient,yourdoctorwilladdmedicationsasneeded.

Retinopathy begins without symptoms, so it is essential to have your eyes

checkedregularlyandtochooseyourfoodsasifyourvisiondependedonit.It

does.

HEALTHYKIDNEYS

Yourkidneysaremadeupofmillionsoftinyfiltrationunits.Theypurifyyour

blood,sendingwasteproductsoutintotheurineandholdingontoproteinsand

othernormalbloodcomponents.Butjustastheretina’stinybloodvesselscanbe

damaged, so can the tiny vessels in your kidneys. High blood pressure, high

bloodglucose,andhighcholesterolassaultthem,leadingtoaconditiondoctors

callnephropathy.

left uncontrolled, kidney damage can progress to the point where your

optionsboildowntodialysisorkidneytransplant.Needlesstosay,youdonot

wantanythinglikethattohappen.Herearethedietstepsyouneedtotake.

First,followthebasicdietguidelinesfordiabetesasdescribedinChapter4.

The need is not just for avoiding fat and cholesterol and keeping your blood

glucoseandcholesteroldown,althoughthoseareveryimportant.Animalprotein

ispartoftheproblem,too,soyouwanttoavoidit.Sinceanimalproteintaxes

thekidneys,gettingyourproteinfromplantsourceshelpsprotectthem.

This isan important point, so stickwith me while Iexplain:Many people

imaginethateggwhite,chickenbreast,orhaddockarehealthfulfoodsbecause

theyarehighinprotein—butthatveryfactiswhatmakesthemundesirable.The

lessanimalproteinyouconsume,theloweryourriskofkidneyproblems.You

aremuchsafergettingyourproteinfromplantsources—beans,vegetables,and

grains,forexample.

A low-fat, vegan diet is not only free of animal protein, cholesterol, and

animal fat, it also helps bring down high blood pressure,

 which is also

importantforprotectingyourkidneys.

It goes without saying that you should avoid tobacco. Among its many ill

effects,smokingdamagesbloodvessels.

Ifyourbloodpressure,glucose,orcholesterolremainshighdespiteyourbest

efforts, yourdoctor will prescribe medicationsto bring it under control.Some

doctors prescribe medications even if your tests are in the normal range, as a

meansofprotectingkidneytissues.Thisisdoneonanindividualizedbasis.

Inarecentstudybyourresearchteam,wetrackedthekidneyhealthofour

participants.Theydutifullycollectedtheirurinetwiceovertwo24-hourperiods

so we could measure their albumin losses (your doctor will probably use less

arduoustests).Theydidthisbeforebeginningtheirassignednewdietsandagain

afterfollowingthemfor22weeks.

During this time, a group following a “conventional” diet that involved

limited calories and carbohydrates had a 21 percent average drop in albumin

losses.That’sachangeintherightdirection.However,agroupfollowingalow-

fatvegangrouphadtheadvantageofconsumingnoanimalprotein,animalfat,

orcholesterol,anditsaveragealbuminlosseswerereduced56percent,thatis,

theyfelltolessthanhalfoftheirbeginningvalues.

GETTINGHEALTHYANDSTAYINGTHATWAY

If you have been gaining weight, needing more and more medications, or

developingcomplications,mygoalistohelpyouchangecourse.Wenowknow

thatitispossibletoloseweighteffectivelyandpermanently,reduceoreliminate

medications, reverse heart disease, and even improve the symptoms of

neuropathy. If you thought you had to surrender to advancing symptoms, it’s

timetothinkagain.Youarenowinthedriver’sseat.

CHAPTER14

InformationforClinicians

Althoughthisbookisintendedasatoolforpeoplewithdiabetes,thereareafew

keypointsIwouldliketomentiontophysiciansandotherhealthcareproviders.

Asyouwillsee,thisprogramisbothveryeffectiveandhighlyengaging.While

healthcareprovidersareusedtoseeingtheirpatientsbecomingfrustratedwith

typical “diabetes diets” and requiring ever-higher medication dosages, both

physiciansandpatientsfindthisapproachfreshandrewarding.

Healthcareprovidersplaykeyrolesforindividualsonthisprogram,justas

theydowithanydiabetestreatmentprogram.Theyeducateandencouragetheir

patients,guidethemalongtheway,andmonitortheirprogress.

Intheresearchstudieswehaveconducted,wehavefoundthatmanypatients

treatedwithinsulinorinsulinsecretogogueshavehypoglycemicepisodesasthey

improvetheirdiets.Asyourpatientsembarkonthisnewdiet,youwillneedto

prepare them for that possibility and be ready to reduce their medications as

needed. It is also important that they understand that the hypoglycemia was

causedbythemedications,notbyanydefectintheirphysiology.Moreonthis

below.

THEROLEOFTHEHEALTHCAREPROVIDER

There are many ways physicians and other health care providers can help

patientsastheybeginmajordietarychanges.First,ofcourse,isencouragement.

Manypatients haveseen theirparents orgrandparents endup withfrightening

diabetes complications, such as eye problems, loss of kidney function, or

amputations, and many have already begun to experience neuropathy or other

problems by the time they decide to take the disease seriously. They need to

know thatthey can avoid these problems—asindeed they can—if theyfollow

youradvice,includingmaintainingagooddiet.

Itishelpfulforthemtoknowthatthisisnotthesamediabetesdiettheymay

havealreadytriedandthattheywillneedtolearnafewnewtricks.Theywill

discovernewproducts,newrestaurants,andperhapsnewmenuitemsattheirold

favoriterestaurants.Themosthelpfulphysicianslearnaboutthesedietchoices,

too.Ifyouhavenotyettriedalow-fat,vegandiet,Iwouldstronglyencourage

youtodoso.Apartfromitshealthbenefits,theexperiencewillalsoprepareyou

toanswerpatients’questionsandofferencouragement.

Onewaytohelppatientsgetstartedistoaskthemtotakeaweektotryout

healthfulveganfoods.Theideaisnottogiveupanything.Rather,theyarejust

tryingoutsomehealthfulbreakfasts,lunches,dinners,andsnacks.Inafewdays,

theywillhavefoundmanygoodideas(moreonthisinChapter5).

Then identify a limited period—say, 3 weeks—in which to give the diet a

goodtry.Fornow,thereisnoneedtocommittoitforever,butduringthisshort

period,they woulddo wellto followit 100percent sothey canexperience its

fulleffect.Oncetheyseehowitworks,theywillwanttocontinue.

Avoidthetemptationtowaterdownthediet.Clinicianswhotellpatientsto

followadiet“mostofthetime”orto“justdothebestyoucan”tacitlyencourage

themtodeviatefromit.Weneverdothatwhenpatientshavealcoholortobacco

problems,becauseweknowthatitiseasiertosticktoaconsistentprogramthan

totrytonegotiatewiththeseproblemsubstances.Thesameistrueoffood;itis

bettertoencouragepatientstogiveit100percent,neversettingafootwrong.

Occasionally, some patients will slip back into their old diet habits. When

thathappens,theywillalmostinstantlynoticethattheynolongermanagetheir

weightaswell,andtheirbloodglucoselevelswillstarttoclimbagain.Theywill

alsoarriveatyourofficewithaheavyburdenofguilt.Manywillspeakoffoods

as“sinful,”“decadent,”etc.Isuggestthatyouremainpositive,avoidmoralizing,

and return the focus to biology, which is where it belongs. Patients who have

returned fat to their diets may well be packing their cells with more

intramyocellular lipid, which is likely to harm their insulin sensitivity.

Encouragethemtodustthemselvesoffandgetbackonthewagon.

Somepatientsneedtobeencouragedtoeatcarbohydrate-richfoods.Because

ofthecarbohydratecountingtheyhavealreadylearned,theymayhavecometo

seeallcarbohydratesasunhealthful.Thisfeelingwasaidedandabettedbythe

never-endinglow-carbohydratedietcraze.Itisimportanttoremindpatientsthat

countries whose populations have traditionally consumed high-carbohydrate

diets—suchas Asiancountries, whererice andnoodles aredietarystaples and

meatanddairyconsumptionismuchlessprevalentthaninWesterncountries—

havehistoricallyhadverylowdiabetesrates.

You can also help patients ensure nutritional adequacy by asking them to

takeadailyB

supplement.Thisisgoodadviceforallpatients.

HYPOGLYCEMIA

Patients who are taking insulin or insulin secretogogues are subject to

hypoglycemia. When they improve their diets and begin to lose weight,

hypoglycemicepisodesarecommon.Inmyexperience,mostpatientsoninsulin

andabouthalfofallpatientsonasulfonylureawhobeginalow-fat,vegandiet

havehypoglycemicepisodes,usuallywithinthefirstseveralweeks.

Patients will be delighted to know that they have improved so much that

theirmedicationsarenowtoostrong,buttheywillalsobeconcernedaboutwhat

hypoglycemiameans.Itisimportantforthemtounderstandthatitwascaused

by their medication and that it does not indicate that there is anything wrong

withthem.Itisalsoessentialforthemtoknow,rightfromtheoutset,whattodo

and whom to call when these episodes happen. Of course, the initial steps—

checkingtheirbloodglucoseandtakingglucosetabletsorfood—arethingsthey

candoontheirown.Butitisimportanttoprovidespecificinstructionsandto

askpatients tocarryyour telephonenumber (orthatof anofficebackup)with

them and use it as necessary—even on weekends—so you can adjust their

medications. You will find my instructions for patients on dealing with

hypoglycemiainGlucoseTesting.

ADDITIONALRESOURCES

Registered dietitians, as you know, are indispensable allies in your work with

diabetes patients. Ideally, you will want to work with a dietitian who is a

certified diabetes educator and a member of the Academy of Nutrition and

Dietetics’ Vegetarian Nutrition Dietetic practice Group, which includes a large

numberofRDsskilledintheuseofvegetariandiets.

ThePhysiciansCommitteeforResponsibleMedicine(PCRM)providesfree,

noncommercialnutritioninformation,includingcontinuingmedicaleducationon

its Web site, PCRM.org, as well as guidance on how to begin low-fat, vegan

diets. It provides hundreds of recipes, shopping lists, and other user-friendly

information.Pleaseuseitandencourageyourpatientstodosoaswell.Theywill

especially like our 21-Day Vegan Kickstart, which offers 3 weeks of menus,

recipes,andcookingvideosinseverallanguages,allforfree.

Ifyouwouldliketojoin inour worktopromotehealthfuldietsand tackle

otherissuesinmedicineandresearch,IhopeyouwillconsiderjoiningPCRM.

Members receive our quarterly magazine, Good Medicine, and can sign up to

receive pCRM’s Breaking Medical News, a free, noncommercial service that

alertsyoubye-mailwhennewstudiesareabouttobreak.

MenusandRecipes

ThefollowingmenusandrecipesweredevelopedandtestedbyBryannaClark

Grogan, a veteran chef, recipe developer, and food writer. Originally from

California,BryannanowlivesinBritishColumbia.Hermanycookbookscover

anenormousrangeoffoodsandcookingstyles,fromquickandeasyrecipesto

manykindsofethniccuisine.

Bryanna’srecipesarefull-bodied,savorydisheswithaspecial“something.”

You will notice that their flavors go beyond the tastes and aromas of the

individualingredients.Theblendsofsimplefoodsandwell-chosenspicesmake

eachrecipespecial.

This recipe collection is intended for a wide range of tastes and

temperamentsandincludesbothsimpleandmoreadventurousofferings.When

we have included an unusual ingredient, you can find more information in

Appendix 2. Thanks to Gabrielle Turner-McGrievy, PhD, RD, and Jennifer

Reilly,RD,whocontributedadditionalrecipes.

HOWTOSTEAM-FRY

Some recipes call for steam-frying, a technique for sautéing or stir-frying

withoutfat.Hereishowtodoit.

Placeaheavynonstickskilletorstir-frypanovermediumheatandaddthe

ingredientstobecooked(e.g.,choppedonionsorothervegetables).Thenadd1

to 2 tablespoons of liquid (water, low-sodium vegetable broth, or wine)—just

enoughtokeepthefoodfromsticking.Donotcrowdthepan,orthevegetables

willstew.

Increasetheheattohighandcookuntiltheliquidstartstoevaporate,stirring

withawoodenspatulaorspoonuntilthevegetablesaredonetoyourliking.

You can brown onions perfectly by this method. As soon as the natural

sugarsin theonions starttobrown onthe bottomand edgesof thepan,add a

little more liquid and mix the browned portions with the remaining onions.

Continueuntiltheonionsaresoftandbrown,beingcarefulnottoscorchthem.

Tosteam-fryinamicrowave,useaglassdish,suchasaround10-inchpyrex

bakingdishorpieplate.Addtheingredients,includingthe1to2tablespoonsof

liquid,andcoverwithaglasslidormicrowaveableplate.Microwaveonhighfor

5 minutes or until the vegetables are soft, then add to the recipe. As almost

everyone with a microwave knows, you can cook vegetables in it, but you

cannotbrownthemoranyotherfood.Ifyoulikeabrown,crispytexture,stick

withthestovetopmethod.

7DaysofHealthfulMeals
DAY1
Breakfast
Oatmealcookedwithapples
Soymilk
Lunch
Black-EyedPeaandSweetPotatoSoup
Toastedryeorsprouted-grainbread
Spinachsaladwith mandarinorange segmentsandCreamyPoppySeed
Dressing
Snack
FruitSmoothie
Dinner
Lebanese-StyleLentilsandPasta
Steamedbroccoli
Orange-ApplesauceDateCake
DAY2
Breakfast
2High-ProteinOatWaffles
Slicedberries
Soyyogurt
Lunch
SpinachHummusandvegetablesofchoicewrappedinasprouted-wheat
tortilla

OrangeQuinoaandBulgurTabbouleh
Snack
Bakedcornchips,salsa,andVegetarian“Refried”Beans
Dinner
Indonesian-StyleStir-FriedPasta
Thai-StyleColeslaw
Freshfruit
DAY3
Breakfast
TofuScramblers
Ryetoast
Fruitsalad
Lunch
Paninisandwichmadewithsprouted-grainbread,TofuMayonnaise,low-
fatvegetariandelislices,andarugula
CreamyMushroomBisque
Snack
AppleslicesdippedinLemonCrème
Dinner
LemonandArtichokeTagine
OrangeCouscousPilaf
BabymixedgreenssaladwithCreamyBlackPepperDressing
BerryMousse
DAY4

Breakfast
BreakfastBarleywithFruit
Soymilk
Lunch
RedLentilandSweetPotatoSoup
ItalianStuffedGriddleDumplings
Snack
Rawvegetables
Wholegrainrye-crispcrackers
SpinachDip
Dinner
EggplantParmesan
GreensaladwithBalsamicVinaigrette
BulgurWheatandQuinoaPilaf
Freshfruit
DAY5
Breakfast
Frozenfat-freehashbrownsbakedinanonstickwaffleiron
Low-fatvegetariansausage
Slicedoranges
Lunch
BlackBeanSoftTacos
CherryTomatoandBrownRiceSaladwithArtichokeHearts
Snack
Orange-ApplesauceDateCake

Nondairymilk
Dinner
Balkan-StyleSlow-CookerStew
Crustyryebread
BrusselsSproutswithLemonandVegetarianBacon
Freshfruit
DAY6
Breakfast
MuesliCereal
Soymilk
Freshfruit
Lunch
SloppyJoesforTwoonsprouted-wheathamburgerbuns
Greensalad
Snack
Wholegraincrackers
CypriotYellowSplitPeaandDillSpread
Dinner
WhiteBeanandSweetPotatoStew
Sproutedgrainbuns
SautéedPortobelloMushroomSalad
Cranberry–Orange–PearGranolaCrisp
DAY7
Breakfast

WheatberryPancakeswithapple-cidermaplesyrup
Freshfruit
Lunch
BarleyandWinterSquashChowder
OatmealDropScones
RedCabbageSlawwithCranberriesandApples
Snack
PineappleSherbetPops
Dinner
VegetarianMixed-BeanChiliExpress
TenderBarleyCornbread
BLTSalad
Chocolate-DippedStrawberries

Breakfasts

BreakfastBarleywithFruit

Fordelicioustaste,lotsofsolublefiber,andawonderfullylowglycemicindex,

tryrolledbarley(alsocalledbarleyflakes)foryourbreakfastporridge.Ittakesa

bitlongertocookthanoatmealunlessyousoakitthenightbefore.Servewith

yourfavoritenondairymilkandatouchofbrownsugarorthesweetenerofyour

choice.

⅓cuprolledbarley(barleyflakes)

⅛teaspoonsalt

¾cupwater

1tablespoonwheatbran

½mediumapplewithpeel,coredandchopped,orotherchoppedfruit

1½teaspoonsgroundflaxseed

Thenightbefore:Combinethebarley,salt,andwaterinamicrowaveablebowl,

cover,andrefrigerateovernight.(Usea1-quartorlargerbowl—barleycanreally

boilup!)

Inthemorning:Addthebranandappleorotherfruittothesoakedbarley.Cover

the bowl with a microwaveable plate and microwave on high for 2 minutes.

Finishcookingonmediumfor4minutes.Stirintheflaxseed.

Tocookonthestovetop:Bringthesoakedbarley,bran,andappleorotherfruitto

aboilinasmallnonsticksaucepanoverhighheat,stirring.Reducetheheatto

low,partiallycover,andsimmerforabout15minutes,stirringoccasionally.The

mixture should have the consistency of cooked oatmeal. If it’s too watery,

continuecookingoverlowheattodesiredconsistency.

MAKES1SERVING

Perserving:197calories,6gprotein,8gcarbohydrates,8gsugar,2gtotalfat,

10%caloriesfromfat,0mgcholesterol,42gfiber,252mgsodium

TofuScramblers

It takesabout the sameamount of timeto make Tofu scramblersas it does to

makescrambledeggswhenyouusethehandyhomemademix.Shakeorstirthe

mixbeforemeasuring.Scramblerscanbeusedinbreakfastburritosorsofttacos

madewithsproutedwheatorcorntortillas,toppedwithsalsa,orusedinvegan

huevosrancheros.

ScramblerMix

1cupnutritionalyeastflakes

5tablespoons+1teaspoononionpowder

4teaspoonscurrypowder

4teaspoonssalt

4teaspoonsgroundturmeric

4teaspoonsgroundcumin

Scramblers

1½teaspoonsTofuscramblerMix

4ouncesreduced-fatextra-firmsilkentofu,crumbled

2tablespoonsreduced-fatsoymilk(optional)

Forthemix:Blendtheyeastflakes,onionpowder,currypowder,salt,turmeric,

andcumininadryblenderormini-processor.Storeinacoveredjar.

For the scramblers: Combine the scrambler mix and tofu well in a medium

bowl.Addthesoymilk,ifdesired.Cookthemixtureinaheavynonstickskillet

untilitreachesthedesiredconsistency,stirringconstantlywithaplasticspatula.

To microwave, combine the ingredients in a microwaveable dish, cover, and

cookonhigh(for4ounces,about2minutes;for8ounces,about3½minutes;for

12ounces,about5minutes;andfor16ounces,about7½minutes).

MAKES1SERVING

Perserving:54calories,9gprotein,3gcarbohydrates,1gsugar,1gtotalfat,

15%caloriesfromfat,0mgcholesterol,1gfiber,252mgsodium

Variations

If you like, add chopped vegetarian bacon or ham; vegetarian bacon bits; or

steam-friedchoppedonions,scallions,mushrooms,bellpeppers,ortomatoes.If

cookinginthemicrowave,placethevegetablesinthebottomofthedish,putthe

tofu(mixedwiththescramblermix)ontop,andcookasusual,thenstirtogether

beforeserving.

MuesliCereal

Bircher muesli was invented in Switzerland as a nutritious raw but digestible

breakfastcereal.Youcanbuyexpensivecommercialversions,buttheoriginalis

lowinfat,easytomake,andquick,aslongasyouremembertostartthenight

before.Servemuesliwithreduced-fatnondairymilkorsoyyogurt;brownsugar,

maplesyruporagavesyruptotaste;andfreshfruit(suchasberries),ifdesired.

1½cupsrolledoatsorotherrolledwholegraincereal

1½cupswater

2tablespoonswheatbran

2tablespoonscurrants,raisins,orotherdriedfruit

¼teaspoonsalt

2mediumappleswithpeel,grated

3tablespoonslemonjuice

The night before: Combine the oats and water in a bowl and refrigerate

overnight.

Just before serving: Add the bran, currants or raisins, salt, apples, and lemon

juicetothesoakedoats.

Note: To make 1 serving, use 6 tablespoons oats; 6 tablespoons water; 1

teaspoonbran;1teaspoondriedfruit;apinchofsalt;½smallapple,shredded;

and2¼teaspoonslemonjuice.

MAKES4SERVINGS

Perserving:173calories,6gprotein,36gcarbohydrates,11gsugar,2gtotal

fat,10%caloriesfromfat,0mgcholesterol,6gfiber,122mgsodium

OatmealDropScones

Traditional Scottish skon recipes contained no fat at all. They were eaten

immediately, warm and fresh, as these should be. Enjoy them with low-sugar

jam.

1cupold-fashionedoats

1¼cupswholewheatpastryflour(notregularwholewheatflour)

1teaspoonsugar

½teaspoonbakingsoda

½teaspoonsalt

1¼cupsreduced-fatsoymilk

1tablespoonlemonjuiceorvinegar

Sugarorcarawayseed

Preheattheovento400°F.Grindtheoatstoafinemealinadryblender.Pour

intoamediumbowlandaddtheflour,sugar,bakingsoda,andsalt.Mixwell.

Mixthesoymilkandlemonjuiceorvinegarinasmallbowl.Pourintothedry

mixture and stir briefly with a fork. Drop by large spoonfuls onto 2 nonstick

baking sheets (or baking sheets lined with parchment), making 12 mounds.

Smooththetopsabitwithwetfingertips.Bakeforabout15minutes.Splitwith

aforkwhilestillhot.

Forabannockshape:Dividethedoughinhalf.Withwethands,patthedough

pieces into 8" circles in two 9" nonstick cake pans (or cake pans lined with

parchment cut to fit). Score each circle into 6 wedges and bake for 15 to 20

minutes.

Sprinklewiththesugarorcarawayseed.

MAKES12SERVINGS

Perserving:77calories,3gprotein,15gcarbohydrates,1gsugar,1gtotalfat,

9%caloriesfromfat,0mgcholesterol,2gfiber,144mgsodium

Variations

CurrantScones:Add¼to½cupdriedcurrants.Youcanalsoadd¾cupgrated

apple.

HerbScones:Add½cuplooselypackedchoppedfreshherbsofyourchoice.

HerbBannock:Thisresemblesafocaccia,isquicktomake,andisagreatsnack.

Add½cupfreshherbstotheoatmealsconedough.Dividethedoughinhalfand

followtheinstructionsformakingthebannockshape.Makeindentationsallover

thedough with your fingertips. Spray the topslightly withwater from apump

sprayerandsprinklewithcoarsesaltorsoyParmesan,ortopwithsteam-fried

orgrilled choppedmushrooms, garlic, bellpeppers, and/oronions. Servewith

balsamicvinegarfordipping.

TenderBarleyCornbread

You can whip up this high-fiber, low-fat cornbread fast, and it bakes in 15

minutes.Usestone-groundcornmealifyoucan.

¾cupyellowcornmeal

½cupbarleyflour

⅓cupwholewheatflour(regularorpastryflour)

2tablespoonssugar

2teaspoonsbakingpowder

½teaspoonsalt

¼teaspoonbakingsoda

1cupreduced-fatsoymilk

¼cupunsweetenedapplesauce

Preheattheovento425°F.Whisktogetherthecornmeal,barleyandwholewheat

flours,sugar,bakingpowder,salt,andbakingsodainamediumbowl.Addthe

soy milk and applesauce and stir just until mixed. Scrape into an 8" × 8"

nonstick baking pan and smooth the top. Bake for 15 minutes. Cut the hot

cornbreadinto6equalpieces.

MAKES6SERVINGS

Perserving:150calories,4gprotein,32gcarbohydrates,5gsugar,1gtotal

fat,6%caloriesfromfat,0mgcholesterol,3gfiber,237mgsodium

High-ProteinOatWaffles

If you didn’t make these crisp, ultra-nutritious waffles yourself, you’d never

guessbeans wereamongtheingredients. Soakingthebeans takesjustminutes

before you retire for the night, and in the morning, you can make the batter

quicklyintheblender.(Note:Tocookwaffleswithoutaddedfat,youwillneeda

good-qualitynonstickwaffleiron.)

These waffles take a little longer to bake than ordinary waffles (about 8

minutes),soyoumaywanttomakethemaheadoftime.Theycanbereheated

quicklyinatoaster.Toppedwithchiliorcreamedvegetables,theymakeagreat

lunchorsupper.Forgluten-freewaffles,substitutebrownriceflakesorquinoa

flakesfortheoats.

½cupdriedcannellini,whitekidney,orgreatnorthernbeans

2¼cupswater

1¾cupsold-fashionedoats

2tablespoonssugaror1tablespoonagavenectar

¾tablespoonwholeflaxseed

1tablespoonbakingpowder

1½teaspoonsvanillaextract,or¾teaspoonvanillaextractand¾teaspoon

orange,almond,orcoconutextract

1teaspoonsalt

The night before: Place the beans in a large bowl and cover generously with

water.Refrigerateovernightorforuptoaweek.

Inthemorning:Drainthebeans,discardingthesoakingwater.Placeinablender

with2¼cupsfreshwaterandtheoats,nectar,flaxseed,bakingpowder,vanilla,

andsalt.Blenduntilsmooth,light,andfoamy.Setasideandpreheatanonstick

waffleiron.

Pouragenerous⅓cupofbatterontothehotwaffleironforeach4"waffle,close

theiron,andcookforaminimumof8minutes.Iftheironishardtoopen,letthe

wafflecookforanotherminuteortwo.

Repeatwiththeremainingbatter,blendingbrieflybeforepouringeachwaffle.If

thebatterthickens whilestanding,addenough watertoreturnit toitsoriginal

consistency.

The waffles should be golden brown and crisp. Serve immediately or cool

completelyonarackandfreezeinanairtightcontainer.Servewithyourfavorite

toppings.

MAKESTEN4"WAFFLES(5SERVINGS)

Perserving:196calories,10gprotein,35gcarbohydrates,2gsugar,3gtotal

fat,11%caloriesfromfat,0mgcholesterol,6gfiber,386mgsodium

WheatberryPancakes

Whowouldguessthatwiththehelpofyourblender,youcouldmakedeliciously

lightpancakesfromfreshlygroundwheatinminutes?Trythese!Leftoverbatter

worksgreatforwaffles,too.

1cupswheatberries(wholewheatkernels)

1tablespoonwholeflaxseed

2cupswater

⅓cupchickpeaflour(besan)orlow-fatsoyflour

1tablespoonsugar

2teaspoonslemonjuice

2teaspoonsbakingpowder

½teaspoonbakingsoda

½teaspoonsalt

Place the wheat berries, flaxseed, and water in a blender and process at high

speedforabout2minutes.Addtheflourandprocessfor2to3minutesoruntil

verysmooth.Addthesugar,lemonjuice,bakingpowder,bakingsoda,andsalt

andprocessuntilwellmixed.

Heataheavynonstickgriddleorskillet(anonstickelectricgriddlecooksvery

evenly)overhighheatuntildropsofwaterdanceonthesurfaceandthenquickly

disappear. Reduce the heat to medium-high. Working in batches if necessary,

pourdollopsofbatterquicklyontothegriddle,leavingspacetoexpand.When

bubbles appear on the surface, gently flip the pancakes. Don’t overcook; they

shouldbeabitpuffywhenyoutakethemoffthegriddle,sotheyarelightand

cakey.

MAKESTWELVE4"PANCAKES(3SERVINGS)

Perserving:261calories,11gprotein,53gcarbohydrates,6gsugar,3gtotal

fat,9%caloriesfromfat,0mgcholesterol,9gfiber,534mgsodium

FruitSmoothie

Thisquickandeasyrecipeisgreatwaytostartyourday—orgiveyouahealthy

boostanytime.

½cupunsweetenedappleororangejuice

½cupreduced-fatsoymilk

½cupfrozenblueberriesorotherberries

½cupfrozenpeaches

1tablespoonsoyproteinpowder

Combinethejuice,soymilk,berries,peaches,andproteinpowderinablender

orfoodprocessor.Blenduntilverysmooth.

MAKES1SERVING

Perserving:148calories,4gprotein,32gcarbohydrates,13gsugar,2gtotal

fat,9%caloriesfromfat,0mgcholesterol,3gfiber,65mgsodium

Dips,Spreads,andDressings

Low-FatGuacamole

This“mock-amole”iscreamyandtasty.Itisdeliciouswithbakedcorntortilla

chips.

5ouncesfreshgreenbeansorfrozensmallwholegreenbeans

5ouncesfrozenbabylimabeans

½cupreduced-fatfirmorextra-firmsilkentofu

3tablespoonslemonjuice

2clovesgarlic,crushed

¾teaspoonsalt

½teaspoongroundcumin

¼cupchunkyno-sugar-addedtomatosalsa

Cook the green beans and lima beans in enough water to cover for about 5

minutes or just until tender but not mushy. Drain well, transfer to a food

processor,andblenduntilsmooth.

Addthetofu,lemonjuice,garlic,salt,andcuminandblenduntilsmooth.Add

thesalsaandpulsebrieflytomix.Scoopintoacoveredbowlandrefrigerate.

MAKES2CUPS

Per¼cup:37calories,2gprotein,7gcarbohydrates,1gsugar,0.5gtotalfat,

5%caloriesfromfat,0mgcholesterol,2gfiber,226mgsodium

Vegetarian“Refried”Beans

Thisfat-freeversionofrefriedbeanshasalighttextureandcanbemadewitha

varietyofbeans.Italsomakesagreatwarmbeandiporadeliciouscoldspread

forsandwiches,wraps,orcrackers.

4½cupscookedor3cans(15ounceseach)black,smallred,kidney,orpinto

beans,rinsedanddrained

1smallonion,finelychopped

2tablespoonsredwinevinegar

1teaspoonsalt

1teaspoongroundcumin

1teaspoondriedoregano

1teaspoondriedgarlicgranules

1teaspoonchilipowder

Hot-peppersaucetotaste(optional)

Afewdashesofliquidsmoke(optional)

Place the beans, onion, vinegar, salt, cumin, oregano, garlic granules, chili

powder, hot-pepper sauce, if desired, and liquid smoke, if desired, in a food

processor.Blendforseveralminutesoruntilverysmooth.Transfertoaserving

bowl,cover,andrefrigerate.

Forahotdip,microwaveonhighforabout3minutesorheatinaskillet,stirring

constantly.

MAKES4CUPS

Per¼cup:68calories,4gprotein,12gcarbohydrates,0.5gsugar,0.5gtotal

fat,4%caloriesfromfat,0mgcholesterol,4gfiber,120mgsodium

SpinachHummus

Most versions of this popular Middle Eastern chickpea dip are chock-full of

olive oil and sesame tahini. This recipe contains a little tahini and plenty of

spinach or other greens for good nutrition and lots of color. Serve with raw

veggiesandwedgesofsprouted-wheatpitabreadorwithfat-freedarkrye-crisp

crackers.Heatingthechickpeasbeforeprocessingmakesacreamierhummus.

1package(10ounces)frozenspinach,thawed

2cupswell-cookedchickpeasor1can(19ounces)chickpeas,heatedand

drained

⅓cuplemonjuice

1tablespoonsesametahini

4–6clovesgarlic

1½teaspoonssalt

1teaspoongroundcumin

¼teaspooncayennepepper

Squeezeasmuchliquidfromthespinachasyoucanandchopwithasharpknife.

Setaside.

Place the chickpeas, lemon juice, tahini, garlic, salt, cumin, and cayenne in a

food processor. Blend until as smooth as desired, adding a bit of water if

necessary (it will thicken somewhat in the refrigerator). Add the spinach and

blendbriefly.

Transfertoaservingbowl,coverwithplasticwrap,andrefrigerateuntilreadyto

serve.

MAKESABOUT3½CUPS

Per¼cup:107calories,7gprotein,19gcarbohydrates,0.5gsugar,2gtotal

fat,13%caloriesfromfat,0mgcholesterol,6gfiber,336mgsodium

Variations

Trythisrecipewithcookedorthawedfrozenkale,Swisschard,orcollardgreens

insteadofspinach.

For a more traditional hummus, omit the greens and decrease the salt to 1

teaspoon,thecuminto½teaspoon,andthecayennetoapinch.

Fordelicious red pepperhummus,make thetraditionalhummus variationand

add½cupdrainedandrinsedroastedredpeppersfromajarwhenyouprocess

thechickpeas.

CypriotYellowSplitPeaandDillSpread

Thiseasyspreadisdeliciouswithdarkrye-crispcrackersorsprouted-wheatpita

wedges.Thegarlicmellowsconsiderablywhencooked.

1cupdriedyellowsplitpeas

7clovesgarlic

1smallonion,chopped

1teaspoonsalt

3cupswater

3tablespoonsfreshlemonjuice

2teaspoonsdrieddillweedor2tablespoonschoppedfreshdill

Freshlygroundblackpeppertotaste

Paprika(optional)

1sprigfreshdill(optional)

Combinethesplitpeas,6ofthegarliccloves,onion,salt,andwaterinamedium

saucepan.Bringtoaboil,skimmingoffanyfoam.Reducetheheat,cover,and

simmerfor30minutes.

Transfertoafoodprocessororblenderandprocess,oruseahand-heldblender

inthepan.(Removethe“pusher”fromthetopofthefoodprocessorsohotair

canescape.Covertheholelooselywithafoldedcleanclothwhileprocessing.)

crush the remaining garliccloveand add to the mixture along with the lemon

juiceanddill.Processuntilverysmooth.Seasonwiththepepper.

Pourintoadecorativeservingbowl,cover,andletcool.Garnishwiththepaprika

anddillsprig,ifdesired.

Thisspreadisbestservedatroomtemperature.Ifyoustoreitintherefrigerator,

simplybringittoroomtemperaturebeforeserving.

MAKES2½CUPS

Per¼cup:74calories,5gprotein,14gcarbohydrates,2gsugar,0.5gtotal

fat,2%caloriesfromfat,0mgcholesterol,5gfiber,193mgsodium

RedWineVinaigrette

This is a good basic dressing for many types of salads. Unlike plain juice or

water,theoilsubstitutewillhelpthedressingsticktothegreens.Iliketomake2

cupsatatimeandrefrigeratetheextra.

Fat-FreeoilSubstitute

1cupcoldwater

1tablespoonlow-sodiumvegetarianbrothpowder

2teaspoonscornstarch

Dressing

1¼cupsFat-FreeOilSubstitute

¼cupredwinevinegar

1tablespoonbalsamicvinegar

1clovegarlic,crushed

1teaspoonsalt

1tablespoonDijonmustard(optional)

1tablespoonbrownsugar(optional)

Fortheoilsubstitute:Placethewaterinasmallsaucepanandwhiskinthebroth

powder andcornstarch. Cook over medium-highheat, stirring constantly, until

thickenedandclear.

For the dressing: Whisk, shake, or blend the oil substitute, red wine and

balsamic vinegars, garlic, salt, mustard, if desired, and sugar, if desired, until

wellmixed.Transfertoajarandrefrigerate.

MAKES1½CUPS

Per2tablespoons:6calories,0.5gprotein,2gcarbohydrates,0gsugar,0g

totalfat,0%caloriesfromfat,0mgcholesterol,0.5gfiber,160mgsodium

Variation

BalsamicVinaigrette:Omittheredwinevinegaranduse5tablespoonsbalsamic

vinegar.Usetheoptionalmustardandbrownsugar.

Per2tablespoons:11calories,0.5gprotein,3gcarbohydrates,1gsugar,0.5g

totalfat,3%caloriesfromfat,0mgcholesterol,0.5gfiber,176mgsodium

SpinachDip

Serve this blender dip with raw vegetables and/or fat-free dark rye-crisp

crackers.

20ouncesreduced-fatextra-firmsilkentofu

¼cuplemonjuice

1envelopeLiptonRecipeSecretsVegetableSoupMix

½teaspoonsalt

1package(10ounces)frozenchoppedspinach,thawedandsqueezeddry

2scallions,minced

1can(8ounces)waterchestnuts,drainedandchopped(optional)

1tablespoonvegetarianbaconbits(optional)

Place the tofu, lemon juice, soup mix, and salt in a food processor and blend

untilsmooth.Addthespinach,scallions,waterchestnuts,ifdesired,andbacon

bits, if desired, and pulse until mixed. Transfer to a serving bowl, cover, and

refrigerateuntilreadytoserve.

MAKES4CUPS(12SERVINGS)

Perserving:16calories,1gprotein,3gcarbohydrates,1gsugar,0.5gtotal

fat,10%caloriesfromfat,0mgcholesterol,1gfiber,226mgsodium

CreamyPoppySeedDressing

This quickand easy dressingis very lowin fat. With just theright amount of

sweetness,it’sgreatonfruitsaladsandspinachsalads.

8ouncesreduced-fatfirmorextra-firmsilkentofu,crumbled

6ounces(½can)frozenapplejuiceconcentrate,thawed

6tablespoonsreduced-fatsoymilk

3tablespoonscidervinegar

1tablespoonpoppyseeds

1½tablespoonschoppedonion

1½tablespoonsdijonmustard

1scantteaspoonsalt

Placealltheingredientsinablenderandprocessuntilsmooth.Transfertoajar

andrefrigerate.Shakebeforeserving.

MAKES2CUPS

Per¼cup:45calories,3gprotein,7gcarbohydrates,1gsugar,1gtotalfat,

18%caloriesfromfat,0mgcholesterol,0.5gfiber,268mgsodium

CreamyBlackPepperDressing

Thisissuretobea favorite,especiallyifyou areafanofspinach salads.The

blenderisthekeytothecreamytexture.

1½tablespoonslow-sodiumvegetarianbrothpowder

1package(12.3ounces)reduced-fatfirmsilkentofu

1largeclovegarlic,finelychopped

3tablespoonsfreshlemonjuice

1tablespoonricevinegar

1tablespoonnutritionalyeastflakes

1½teaspoonswholeblackpeppercorns

1teaspoonmiso

1teaspoonsugar

¾teaspoonsalt

⅔cupwater

Placealltheingredientsinablenderandprocessuntilverysmooth.Transfertoa

jarandrefrigerate.Shakewellbeforeserving.

MAKES2CUPS

Per2tablespoons:15calories,2gprotein,2gcarbohydrates,0.5gsugar,0.5g

totalfat,11%caloriesfromfat,0mgcholesterol,0.5gfiber,123mgsodium

Soups

DutchGreenPeaSoup

A very satisfying meal on a cold day! Serve this soup hot along with dark

pumpernickelbread.

1cupgreensplitpeas

8cupslow-sodiumvegetarianbroth

1tablespoonvegetarianbaconbits

2mediumneworredpotatoes,peeledandchopped

2mediumleeks,chopped,includinganytendergreenparts

½cupchoppedcelery,includingleaves

½teaspoondriedsavory

½teaspoonliquidsmoke

1package(10–12ounces)low-fatvegetarianhotdogsorsausages,sliced

diagonallyintochunks

Salttotaste

Freshlygroundblackpeppertotaste

Bring the split peas, broth, and bacon bits to a boil in a large saucepan,

skimmingoffanyfoam.Reducetheheat,cover,andsimmerforabout3hours.

Addthepotatoes,leeks,celery,savory,liquidsmoke,andhotdogsorsausages.

Simmerfor30minutesoruntilthepotatoesaretender.Seasonwiththesaltand

pepper.

MAKES8SERVINGS

Perserving:184calories,15gprotein,27gcarbohydrates,3gsugar,3gtotal

fat,11%caloriesfromfat,0mgcholesterol,7gfiber,36mgsodium

BarleyandWinterSquashChowder

Thisisalovelysoupforacoldevening.

4cupslow-sodiumvegetarianbroth

1poundwintersquash,peeled,seeded,andcutinto¾"cubes

½largeonion,chopped

6ounceslow-fatchickensubstitutestrips,suchasButlerSoyCurls,

reconstituted

¾cuppearledbarley

8ouncesredpotatoes,chopped

¼cupchoppedceleryleavesandtops

1½teaspoonsvegetarianbaconbits

1bayleaf

½teaspoondriedthyme

½teaspoondriedsavory

1½cupsreduced-fatsoymilk

Salttotaste

Freshlygroundblackpeppertotaste

Choppedfreshparsley(optional)

Placethebroth,squash,onion,chickensubstitutestrips,barley,potatoes,celery,

baconbits,bayleaf,thyme,andsavoryinasouppotandbringtoaboil.Reduce

theheattolow,cover,andsimmerfor30minutes.Removethebayleaf,stirin

the soy milk, and season with the salt and pepper. Sprinkle each serving with

choppedparsley,ifdesired.

MAKES6SERVINGS

Perserving:204calories,11gprotein,40gcarbohydrates,4gsugar,1gtotal

fat,4%caloriesfromfat,0mgcholesterol,8gfiber,229mgsodium

CreamyMushroomBisque

A food processor turns this dairy-free soup into a rich, creamy treat with a

delightfulmushroomflavor.

1smallonion,finelychopped

5cupsmushroombroth

1bayleaf

½teaspoondriedthyme

⅔cupold-fashionedoats

12ouncesmushrooms,sliced

2teaspoonslow-sodiumsoysauce

2tablespoonsdrysherry(optional)

Salttotaste

Freshlygroundblackpeppertotaste

VeganParmesancheese(optional)

Steam-frytheonioninaheavynonstickskilletovermediumheatuntilsoftbut

notbrowned,addingverysmallamountsofwaterasneededtopreventsticking

andburning.(Orplaceinamicrowaveabledish,cover,andmicrowaveonhigh

for3minutes.)

Placethebroth,bayleaf,thyme,andoatsinamediumsaucepan.Addtheonion

and bring to a boil, then reduce the heat to low, cover, and simmer for 20

minutesoruntiltheoatsaresoft.

Meanwhile,steam-frythemushroomsinalarge,heavynonstickskilletoverhigh

heat, adding a sprinkle of salt and very small amounts of water as needed to

prevent sticking and burning. Cook until the mushrooms release and reabsorb

theirliquid.Removefromtheheatandsetaside.

Whentheoatsaresoft,removethebayleafandpureethesoupuntilcreamywith

ahand-heldblender orinbatchesin ablenderorfoodprocessor.(Removethe

middlepartoftheblenderorfoodprocessor’slidsohotaircanescape.Cover

theholelooselywithafoldedcleanclothwhileblending.)

Return the soup to the pan and add the mushrooms, soy sauce, sherry (if

desired),salt,pepper,andveganParmesan(ifdesired).Servehot.

MAKES4SERVINGS

Perserving:80calories,5gprotein,14gcarbohydrates,3gsugar,1gtotalfat,

12%caloriesfromfat,0mgcholesterol,3gfiber,93mgsodium

Black-EyedPeaandSweetPotatoSoup

ThisdelectablesoupcontainsSoutherningredients—black-eyedpeas,vegetarian

baconandsausage,sweetpotatoes,andgreens.

1largeonion,chopped

3clovesgarlic,minced

6cupslow-sodiumvegetarianbroth

¼cuptomatopaste

3cupscookedor2cans(15ounceseach)black-eyedpeas,rinsedanddrained

2tablespoonsvegetarianbaconbitsorafewdashesofliquidsmoke

2teaspoonsdriedoregano

1bayleaf

½teaspoonsalt

½teaspooncrushedredpepper

4ounceskale,collards,orotherdarkgreens,cleaned,trimmed,andthinly

sliced

1poundsweetpotatoes,peeledandchopped

2vegetarianitaliansausages,suchasLightlifesmartLinksitalianorYves

VeggieSpicyItalianSausage,cutinto¼"slices

Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium

heatuntilsoft,addingverysmallamountsofwaterasneededtopreventsticking

andburning.(Orplaceinamicrowaveabledish,cover,andmicrowaveonhigh

for5minutes.)

Place the broth, tomato paste, black-eyed peas, bacon bits or liquid smoke,

oregano,bayleaf,salt,redpepper,greens,sweetpotatoes,andsausageinalarge

saucepan.Addtheonionandgarlicandsimmerfor30minutesoruntilthesweet

potatoesaretender.Removethebayleafandserveimmediately.

MAKES6SERVINGS

Perserving:257calories,16gprotein,44gcarbohydrates,8gsugar,3gtotal

fat,10%caloriesfromfat,0mgcholesterol,10gfiber,263mgsodium

RedLentilandSweetPotatoSoup

Thisheartysoupmakesagreatlightlunchorastarterforaseveral-coursemeal.

Blendinggivesitadelightfullysmoothtexture.

2smallonions,chopped

½teaspoongroundcumin

½teaspoongroundginger

4cupslow-sodiumvegetarianbroth

2cupscubedpeeledsweetpotatoes

⅔cupredorpinklentils,rinsed

1teaspoonlemonjuice

¼teaspoonsalt

Whitepeppertotaste

Paprika

Steam-frythe onionsin alarge,heavy nonstickskillet overmediumheatuntil

soft, adding very small amounts of water as needed to prevent sticking and

burning.(Orplaceinamicrowaveabledish,cover,andmicrowaveonhighfor5

minutes.)stirinthecuminandgingerandblendwell.

Place the broth, sweet potatoes, and lentils in a medium soup pot. Add the

onions and simmer, uncovered, for about 30 minutes or until the lentils are

tender.Addthelemonjuice, salt,andwhitepepper.Processusinga hand-held

blender in the pan or in batches in a blender or food processor, until creamy.

(Remove the middle part of the blender or food processor lid so hot air can

escape.Covertheholelooselywithafoldedcleanclothwhileblending.)Serve

hotandwithpaprikasprinkledontopofeachbowl.

MAKES4SERVINGS

Perserving:185calories,10gprotein,36gcarbohydrates,4gsugar,1gtotal

fat,3%caloriesfromfat,0mgcholesterol,6gfiber,158mgsodium

SandwichesandSalads

BlackBeanSoftTacos

InMexico,tacosareusuallymadewithfresh,hottortillas(notdeep-friedones).

Thismachine-blendedfillingbringsyouallthetraditionaltasteandheartinessof

therealthing.

TofuSourCream

1package(12.3ounces)reduced-fatextra-firmsilkentofu,crumbled

3tablespoonslemonjuice

½teaspoonsugar

¼teaspoonsalt

Tacos

8corntortillas(6")

1½cupsVegetarian“Refried”Beansmadewithblackbeans

2cups(1recipe)Low-FatGuacamole

1cupno-sugar-addedtomatosalsa

4cupsfinelyshreddedgreencabbageorlettuce

1cupTofusourcream

Forthe tofusour cream: Placethe tofu,lemon juice,sugar,and saltin afood

processor or blender and process until very smooth. Refrigerate in a covered

containerforupto1week.

Forthetacos:Heatthetortillas(seeNote).Spreadabout3tablespoonsofbeans

downthemiddleofeachtortilla.Topwithguacamole,salsa,cabbageorlettuce,

andtofusourcream.Eatoutofhandwithlotsofnapkins!

Note:Ifthetortillasarefrozen,heatthembetweentwomicrowaveableplateson

highforabout1minute,thenturnovertheplatesandheatfor1minutelonger.

Youcansoftenthawedorfreshtortillasinahot,drypan;grillthemquicklyjust

untilsoft;orwraptheminacleankitchentowelmoistenedwithhotwater,then

wraptheminfoilandplacethemintheovenuntilallareheated.Or,wrapthe

tortillasinacleankitchentowelmoistenedwithhotwater,wraptheminfoil,and

bakethemina350°Fovenforabout12minutes.

Ifyouhaveanoninsulatedmicrowaveablesteamer,placealittlehotwaterunder

the steamer tray. Wrap the thawed tortillas in a clean kitchen towel and place

theminthesteamertray.Coverandmicrowavefor2to3minutesfor6tortillas

or 4minutes for 12 tortillas.If you leavethewrapped tortillas inthe steamer,

theywillstayhotduringthemeal.

MAKES8SERVINGS

Perserving:174calories,10gprotein,33gcarbohydrates,3gsugar,1gtotal

fat,7%caloriesfromfat,0mgcholesterol,7gfiber,557mgsodium

AsparagusandVeggieHamPanini

ThisItalianpaniniwillbecomealunchtimefavorite.

2slicesryeorsprouted-grainbread

2tablespoonsTofuMayonnaise

6thinasparagusspears,steamedorroasted

6freshbasilleaves

2sliceslow-fatvegetarianbaconorham,suchasYvesVeggieCanadian

Bacon

Spread each bread slice on 1 side with 1 tablespoon tofu mayonnaise and

assemblethesandwichwiththerestoftheingredientsthewayyoulikeit,being

carefulnottooverfill.

Theeasiestwaytomakepaniniiswithanelectricnonstickpaninipressorclosed

indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as

goldenandcrispasyoulike,cookforafewminuteslonger.Cutthesandwich

intotrianglesandservehot.

Ifyoudonothaveapaninipressorgrill,cookthesandwichinaheavynonstick

skilletoronagriddleovermediumheat,placingaflatheavylidonthesandwich

asyoubrowneachside.

Perserving(usingrye bread):308calories,31g protein,32 g carbohydrates,

0.2gsugar,4gtotalfat,11%caloriesfromfat,0mgcholesterol,6gfiber,825

mgsodium

ItalianStuffedGriddleDumplings(Consum)

This traditional“griddle dumpling”from Romagna isactually a stuffed Italian

flatbread, similar to a calzone but stuffed with greens. This easy version uses

wholewheatpitas.

6wholewheatpitas

½poundSwisschard,beetgreens,spinach,orsavoycabbage,oramixture

½poundbittergreens,suchasarugula,radicchio,rapini,Chinesebroccoli,

mustardorturnipgreens,orcurlyendive

1½teaspoonschoppedgarlic

¼cuplow-sodiumvegetarianbroth

¼teaspoonsalt,andextratotaste

Freshlygroundblackpeppertotaste

Cutthepitasinhalfandopentoformapocket.Wash,trim,andthinlyslicethe

greens.

Placethegarlic,broth,greens,andsaltinalarge,deepnonstickskillet.Bringto

aboil,thencover,reducetheheattomedium,andcookuntiltender.Ifanyliquid

remains,uncoverandcookoverhighheat,stirringconstantly,untilitevaporates.

Seasonwiththesaltandpepperandsetasidetocool.

Drainthegreensandstuffinsidethepitahalves.Heatthefilledpitasonahot,

dry griddle or cast-iron pan over high heat, turning frequently, until hot and

fleckedwithbrownspots.Servehot.

MAKES6SERVINGS

Perserving:188calories,8gprotein,38gcarbohydrates,2gsugar,2gtotal

fat,8%caloriesfromfat,0mgcholesterol,6gfiber,510mgsodium

MediterraneanVeggiePanini

Italiansandwichmaking hasbecomeanart forminthenorthern cityofMilan

andhasspreadalloverEuropeandNorthAmerica.Sandwichbarsinitalyrange

fromhumbleplacestotheheightofsophistication,andsomeofferasmanyas30

varieties.

2slicesryeorsprouted-grainbread,suchasEzekielBread

2tablespoonsfat-freeitalianvinaigrettedressing

2jarredroastedredpeppers,rinsedandpatteddry

1cuptenderkaleleavesorothergreens

2smallfirm,ripetomatoes,sliced(freshRomatomatoesarebestbecausethey

arenotoverlyjuicy)

½cupslicedmarinatedartichokehearts,rinsed,drained,andpatteddry

Moisteneachbreadsliceon1sidewith1tablespoondressingandassemblethe

sandwichwiththerestoftheingredientsthewayyoulikeit,beingcarefulnotto

overfill.

Theeasiestwaytomakepaniniiswithanelectricnonstickpaninipressorclosed

indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as

goldenandcrispasyoulike,cookforafewminuteslonger.Cutthesandwich

intotrianglesandservehot.

Ifyoudonothaveapaninipressorgrill,cookthesandwichinaheavynonstick

skilletoronagriddleovermediumheat,placingaflatheavylidonthesandwich

asyoubrowneachside.

MAKES1SERVING

Perserving (usingrye bread): 311 calories, 13g protein, 49g carbohydrates,

4.9gsugar,3gtotalfat,8%caloriesfromfat,0mgcholesterol,13.3gfiber,849

mgsodium

SloppyJoesforTwo

Here’satastyandhealthfulversionofanoldfavorite.

½smallonion,finelychopped

½smallgreenbellpepper,cored,seeded,andchopped

½smallredbellpepper,cored,seeded,andchopped

6mediummushrooms,chopped

¾cuplow-fatvegetarianhamburgercrumbles

½cupfat-freebarbecuesauce,suchasBull’s-EyeOriginal

1tablespoontomatopastedissolvedin½cuphotwater

2sprouted-wheathamburgerbuns,suchasAlvaradoStreetBakerybuns,split

andtoasted

Steam-frytheonions,peppers,andmushroomsinaheavynonstickskilletover

high heat until softened, adding water by the tablespoon as needed to prevent

stickingandburning.

Addthehamburgercrumbles,barbecuesauce,andtomatopastemixture.Cook,

stirring,untilthesauceisthedesiredconsistency.Spoonoverthesplitbunsor

fillthemlikeasandwich.

MAKES2SERVINGS

Perserving:218calories,14gprotein,40gcarbohydrates,11gsugar,2gtotal

fat,7%caloriesfromfat,0mgcholesterol,6gfiber,508mgsodium

OrangeQuinoaandBulgurTabbouleh

Thisisadeliciousandunusualversionofthewell-knownMiddleeasternsalad.

½cupmedium-grainbulgurwheat

1½cupswater

½cupquinoa

¾cupFat-FreeOilSubstitute

¼cuplemonjuice

1teaspoonsalt

1teaspoongroundcoriander

2pinchesgroundcinnamon

Freshlygroundblackpeppertotaste

2cupschoppedfreshparsley

1cupcookedorcannedblack-eyedpeas,rinsedanddrained

⅔cupchopped,seededgreenbellpepper

½cupchoppedfreshmintorlemonbalm

½cupchoppedscallion

Gratedpeelof2oranges

4jarredroastedredpeppers,rinsedandchopped

Orangewedges(optional)

Mint,parsley,orlemonbalmsprigs(optional)

Soakthebulgurin½cupboilingwaterinalargebowl,covered,for30minutes.

Meanwhile, bring the quinoa and 1 cup water to a boil in a small saucepan.

Reducetheheattolow,cover,andcookfor15minutes.Removefromtheheat

andletstanduntilthebulgurisready.

Whisk or blend together the oil substitute, lemon juice, salt, coriander,

cinnamon,andblackpepperinasmallbowl.Setaside.

Combine the quinoa with the bulgur. Add the parsley, black-eyed peas, bell

pepper,mintorlemonbalm,scallion,orangepeel,redpeppers,andoildressing

andmixwell.Garnishwithorangewedgesandsprigsofmint,parsley,orlemon

balm,if desired. Refrigerate,but letstand atroom temperaturefor 30 minutes

beforeserving.

MAKES8SERVINGS

Perserving:136calories,5gprotein,29gcarbohydrates,2gsugar,1gtotal

fat,7%caloriesfromfat,0mgcholesterol,7gfiber,303mgsodium

CherryTomatoandBrownRiceSaladwithArtichokeHearts

This delicious salad is a complete meal and a great picnic or potluck dish.

Becauseneithertomatoesnorricebenefitfromrefrigeration,itshouldbeserved

atroomtemperature.

3cupscookedbrownbasmatirice,warm

6ouncesmarinatedartichokehearts,rinsedinhotwater,drained,andsliced

1cupchoppedscallions

1½poundsred,yellow,ormixedcherrytomatoes,halved

½cupchoppedfreshbasil

½cupfat-freeItaliandressing

3tablespoonslemonjuice

2clovesgarlic,crushed

¼teaspoonsalt

Freshlygroundblackpeppertotaste

1headcrisplettuce

Placethericeinalargesaladbowlandaddtheartichokes,scallions,tomatoes,

andbasil.Mixgently.

Combine the italian dressing, lemon juice, garlic, salt, and pepper in a small

bowl or jar. Whisk or shake until well blended. Pour over the salad and mix

gently.Serveonbedsoflettuceonindividualplates.

MAKES6SERVINGS

Perserving:153calories,4gprotein,32gcarbohydrates,3gsugar,1gtotal

fat,6%caloriesfromfat,0mgcholesterol,4gfiber,376mgsodium

Thai-StyleColeslaw

This easy coleslaw makes a great winter accompaniment to an Asian meal or

spicesupanyothermeal.

3cupsfinelyshreddedgreenorsavoycabbage

1mediumcarrot,shredded

1smallsweetonion,thinlysliced

2tablespoonsmincedfreshmintor2teaspoonsdriedmint

2tablespoonsmincedfreshcilantro,basil,orparsley

2tablespoonslow-sodiumsoysauce

2tablespoonslimejuice

2tablespoonswater

1tablespoonsugar

1tablespoongratedlimepeel

1½teaspoonstoastedsesameseeds

Combine the cabbage, carrot, onion, mint, and cilantro, basil, or parsley in a

servingbowl.

Combinethesoysauce,limejuice,water,sugar,andlimepeelinasmallbowl.

Pouroverthesalad,mixwell,andrefrigerateuntilreadytoserve.Sprinklewith

thesesameseedsbeforeserving.

MAKES4SERVINGS

Perserving:61calories,2gprotein,13gcarbohydrates,8gsugar,1gtotalfat,

10%caloriesfromfat,0mgcholesterol,3gfiber,334mgsodium

RedCabbageSlawwithCranberriesandApples

Thisisaveryeasy,attractive,anddeliciousmake-aheadsaladforwinterholiday

meals.Ablendermakesthevinaigretteinajiffy.

Cranberry-orangeVinaigrette

¾cupFat-FreeOilSubstitute

½cuporangejuice

⅓cupchoppedfreshorfrozencranberries

2tablespoonsredwinevinegar

1½tablespoonschoppedchivesorscallion

1tablespoonbalsamicvinegar

1tablespoonlemonjuice

1tablespoonsugar

1largeclovegarlic,crushed

1teaspoonsalt

Freshlygroundblackpeppertotaste

Salad

1½poundsredcabbage,thinlysliced(about5cups)

¾cupfreshorfrozencranberries

2crispsweetapples,sliced

For the vinaigrette: Blend the oil substitute, orange juice, cranberries, wine

vinegar,chivesorscallion,balsamicvinegar,lemonjuice,sugar,garlic,salt,and

pepper in a blender. If making ahead, transfer to a covered container and

refrigerate.

Forthesalad:Combine thecabbage,cranberries, andvinaigrettein amedium

saladbowlandtossgently.Coverandrefrigerateforatleast2hourstoallowthe

flavors to blend. When ready to serve, slice the apples (with peel), add to the

salad,andtosswell.

MAKES8SERVINGS

Perserving:70calories,1gprotein,18gcarbohydrates,11gsugar,0.5gtotal

fat,2%caloriesfromfat,0mgcholesterol,3gfiber,251mgsodium

SautéedPortobelloMushroomSalad

Thisisaverysimpleanddelicioussaladfortwo.

8cupscleanedmixedbabysaladgreens

¼cupFat-FreeOilSubstitute

2tablespoonsbalsamicvinegar

1teaspoonDijonmustard

¼teaspoonsalt

¼teaspooncoarselygroundblackpepper

2largeportobellomushrooms

Wineorvegetablebroth

4scallions,sliced

Dividethegreensbetweentwoservingplates.Inasmallbowl,whisktogether

theoilsubstitute,vinegar,mustard,salt,andpepper.Setaside.

Removethestemsfromthemushroomsandscrapeawaythedarkgillswiththe

edgeofaspoon.

Heat a large, heavy nonstick skillet over high heat and add the mushrooms.

Coverandcookuntilslightlybrownedonthebottomsandbeginningtoreleasea

bit of liquid. Add a very small amount of wine or broth as needed to prevent

sticking.Turnthemushroomsandbrowntheotherside.

Quickly slice the mushrooms and place them evenly over the greens. Drizzle

withthedressing,sprinklewiththescallions,andserveimmediately.

MAKES2SERVINGS

Perserving:95calories,7gprotein,19gcarbohydrates,4gsugar,1gtotalfat,

6%caloriesfromfat,0mgcholesterol,7gfiber,308mgsodium

BLTSalad

A salad version of the well-loved sandwich that uses a handy mayonnaise

substitute.Cooks,pluginyourblenders!

Tofumayonnaise

1package(12.3ounces)reduced-fatextra-firmsilkentofu

2tablespoonscidervinegarorlemonjuice

1⅛teaspoonssalt

½teaspoondrymustard

⅛teaspoonwhitepepper

Salad

6cupstornromainelettuce

6cupscubedsprouted-wheatbread,lightlytoasted

4sliceslow-fatvegetarianbacon,suchasYvesVeggieCanadianBaconor

LightlifeFakin’Bacon

2cupschoppedripefirmtomatoes

2scallions,sliced

½cupcidervinegar

⅓cupFat-FreeOilSubstitute

¼cupTofuMayonnaise

5teaspoonssugar

Freshlygroundblackpeppertotaste

For the mayonnaise: Combine the tofu, vinegar or lemon juice, salt, mustard,

andpepperinafoodprocessororblender(orplacetheingredientsinamedium

bowlanduseahand-heldblender)andprocessuntilverysmooth.Itwillkeepin

acoveredcontainerintherefrigeratorforabout2weeks.

Forthesalad:Combinethelettuce,breadcubes,bacon,tomatoes,andscallions

inalargebowl.

Whisktogetherthevinegar,oilsubstitute,tofumayonnaise,sugar,andpepperin

amediumbowluntilwellblended.Tosswiththesalad.Dividethesaladevenly

among4saladbowlsorplatesandserveimmediately.

MAKES4SERVINGS

Perserving:259calories,13gprotein,42gcarbohydrates,11gsugar,2gtotal

fat,8%caloriesfromfat,0mgcholesterol,10gfiber,639mgsodium

MainCourses

Balkan-StyleSlow-CookerStew

Balkancooking issimilar toGreek cuisine.Serve withtoasted sprouted-wheat

breadorbunsfordipping.

3largeonions,sliced

3clovesgarlic,minced

4largered,yellow,green,ormixedbellpeppers,slicedintothinstrips

12ounceslow-fatchickensubstitutestrips,suchasYvesVeggieChicken

TendersorLightlifeSmartMenuChik’nStrips

1can(14ounces)low-sodiumdicedtomatoes

1smalldriedredchilepepper,seeded

½teaspoongroundcloves

½teaspoongroundcinnamon

¼teaspoongroundallspice

2cupslow-sodiumvegetarianbroth

Salttotaste

Freshlygroundblackpeppertotaste

Heatalarge,heavynonstickskilletoverhighheat.Addtheonions,garlic,and

bell peppers. Steam-fry until the onion softens, adding very small amounts of

waterasneededtopreventstickingandburning.

Place the chicken substitute strips in a slow cooker and spoon the cooked

vegetables on top. Stir in the tomatoes (with juice), chile pepper, cloves,

cinnamon, allspice, and broth.Cookon high for 3 hours. Season with the salt

andblackpepper.

MAKES4SERVINGS

Perserving:185calories,19gprotein,30gcarbohydrates,12gsugar,1gtotal

fat,2%caloriesfromfat,0mgcholesterol,9gfiber,550mgsodium

WhiteBeanandSweetPotatoStew

AllyouneediswholegrainbreadtogowiththisItalian-inspiredstew.

1largeonion,chopped

4clovesgarlic,chopped

3cupscookedor2cans(15ounceseach)cannellini,whitekidney,orgreat

Northernbeans,rinsedanddrained

1can(28ounces)low-sodiumdicedtomatoes

1poundsweetpotatoes,peeledandchopped

12ounceskale,strippedfromstalks,washed,thinlysliced,andbriefly

steamed

8ouncescreminimushrooms,sliced

½cuplow-sodiumvegetarianbroth

½cupdryredwine(canbenonalcoholic)or¼cupdrysherry

1tablespoonvegetarianbaconbits

1teaspoonsalt

1teaspoondriedrosemary

1teaspoondriedthyme

1teaspoondriedbasil

1bayleaf

¼teaspooncrushedredpepper

Salttotaste

Freshlygroundblackpeppertotaste

Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium

heatuntilsoft,addingverysmallamountsofwater,wine,orbrothasneededto

prevent sticking and burning. (Or place in a microwaveable dish, cover, and

microwaveonhighpowerfor5minutes.)

Combine the onions and garlic with the beans, tomatoes (with juice), sweet

potatoes,kale,mushrooms,broth,wine,baconbits,salt,rosemary,thyme,basil,

bayleaf,andredpepperinaslowcooker.Cookonlowfor6to7hoursoron

highfor3to4hours.Removethebayleafandseasonwiththesaltandpepper.

MAKES6SERVINGS

Perserving:257calories,14gprotein,50gcarbohydrates,9gsugar,2gtotal

fat,4%caloriesfromfat,0mgcholesterol,12gfiber,418mgsodium

Lebanese-StyleLentilsandPasta

ThisdeliciousLebanesedishmakesafullmeal.

5cupslow-sodiumvegetarianbroth

1cupuncookedbrownlentils,rinsed

2mediumonions,chopped

2clovesgarlic,chopped

1teaspoongroundcumin

4cupschoppedchard,kale,orothergreensor1package(10ounces)frozen

choppedspinach,thawedandsqueezeddry

4ouncesspaghettiorspaghettini(preferablywholewheat),brokeninto4"-

longpieces

¼cupchoppedfreshparsleyorcilantro(optional)pinchofcayennepepper

2tablespoonslemonjuice

Salttotaste

Freshlygroundblackpeppertotaste

Bringthebrothandlentilstoaboilinamediumsaucepan.Reducetheheatto

low,cover,andcookforabout25minutesoruntilthelentilsaretenderbutstill

holdtheirshape.

Steam-frytheonions,garlic,andcumininalarge,heavynonsticksaucepan,stir-

frypan,ordeepskilletuntilsoft,addingverysmallamountsofwaterasneeded

topreventstickingandburning.(Orplaceinamicrowaveabledish,cover,and

microwaveonhighfor7minutes.)

Pourthe lentils andbroth intothepan withthe onions. Addthe greens,pasta,

parsleyorcilantro,ifdesired,andcayenne.Bringtoaboil,thenreducetheheat

tomedium. Cook,uncovered,for about10 minutesoruntil thepasta istender

andmostofthebrothhasbeenabsorbed,leavingasauce.Addthelemonjuice

andmixwell.Seasonwiththesaltandblackpepper.Servehot.

MAKES4SERVINGS

Perserving:318calories,20gprotein,61gcarbohydrates,7gsugar,1gtotal

fat,3%caloriesfromfat,0mgcholesterol,17gfiber,204mgsodium

LemonandArtichokeTagine(MoroccanStew)

ServethisdeliciousstewwithBulgurWheatandQuinoaPilaf.

2tablespoonswholewheatflour

12ounceslow-fatchickensubstitutestrips,suchasYvesVeggieChicken

Tenders,LightlifeSmartMenuChik’nStrips,orMorningstarFarmsMeal

StartersChik’nStrips

1largeonion,sliced

6clovesgarlic,chopped

2cupsslicedmushrooms

1largegreenorredbellpepper,cored,seeded,andcutintochunks

2cupslow-sodiumvegetarianbroth

1tablespoongroundcoriander

1tablespoondriedparsley

½teaspoonblackpepper

¼teaspoongroundturmeric

¼teaspoongroundginger

¼teaspoonpaprika

¼teaspooncrushedredpepper

1lemon,withpeel,slicedandseeded

1jar(7ounces)marinatedartichokeheartquarters,rinsedunderhotwaterand

drained

Salttotaste

Place the flour in a shallow dish and roll the chicken substitute strips to coat.

Place the strips in a large, heavy, deep nonstick skillet or stir-fry pan over

medium-highheatandcookuntilbrowned.Removefromthepanandsetaside.

Addtheonionandgarlictotheskilletandsteam-fryuntilsoft,addingverysmall

amounts of water as needed to prevent sticking and burning. (Or place in a

microwaveabledish,cover,andmicrowaveonhighfor7minutes.)

Addthestrips,mushrooms,bellpepper,broth,coriander,parsley,blackpepper,

turmeric,ginger, paprika,and redpepper. Placethe lemonslices on topof the

stew,cover,reducetheheat,andsimmerfor30minutes.

Removeanddiscardthelemonslices.Stirintheartichokesandcookjustuntil

heated.Seasonwiththesaltandserveimmediately.

MAKES4SERVINGS

Perserving:165calories,20gprotein,25gcarbohydrates,3gsugar,1gtotal

fat,3%caloriesfromfat,0mgcholesterol,10gfiber,584mgsodium

PastawithLentilMarinaraSauce

Redwine(whichcanbeanonalcoholicvariety)lendsarichflavortothissauce,

whichisreadyinthetimeittakestocookthepasta.

1poundpastaofchoice

1jar(26ounces)fat-freelow-sodiumtomato-basedpastasauce

1can(15ounces)lentils,rinsedanddrained

½cupdryredwine(canbenonalcoholic)orlow-sodiumvegetarianbroth

Salttotaste

Freshlygroundblackpepper

Cookthepastaaccordingtopackagedirections,thendrain.

Meanwhile, combine the pasta sauce, lentils, and wine or broth in a medium

saucepan.Heatgentlyandseasonwiththesaltandpepper.Serveoverthepasta.

MAKES5SERVINGS

Perserving:470calories,19gprotein,91gcarbohydrates,9gsugar,2gtotal

fat,3%caloriesfromfat,0mgcholesterol,8gfiber,173mgsodium

VegetarianMixed-BeanChiliExpress

This chili is an absolutely delicious savory treat. Serve it with brown basmati

rice, sprouted-grain bread or buns, corn or sprouted-wheat tortillas, soft fresh

polentaorcornbread,andasalad.Leftoversfreezewell.

6clovesgarlic,mincedorcrushed

1tablespoonchilipowder(preferablyadarkvariety,suchasancho)

1tablespoondriedoregano

1½teaspoonsgroundcumin

½teaspooncrushedredpepper

1can(28ounces)low-sodiumdicedtomatoes

1½cupscookedor1can(15ounces)pintobeans,rinsedanddrained

1½cupscookedor1can(15ounces)blackbeans,rinsedanddrained

1½cupscookedor1can(15ounces)smallredorredkidneybeans,rinsed

anddrained

3cupshotwater

1½cupsdrytexturedvegetableprotein

1cupfrozenwhole-kernelcorn

1largegreenbellpepper,cored,seeded,andchopped

¼cuplow-sodiumsoysauce

1tablespoonhot-peppersauce

1tablespoononionpowder

1tablespoonunsweetenedcocoapowder

1teaspoonsugar

2tablespoonscornmealormasaharina

Salttotaste

Steam-frythegarlicinalarge,heavynonstickskilletfor2minutes.Addthechili

powder, oregano, cumin, and red pepper and stir-fry for 1 minute. Add the

tomatoes(withjuice),beans,hotwater,vegetableprotein,corn,bellpepper,soy

sauce,hot-peppersauce, onionpowder,cocoa, andsugar.Bringto aboil,then

reduce the heat, cover, and simmer for 15 to 30 minutes. During the last 5

minutesofcooking,sprinklethecornmealormasaharinaoverthetopandstirin

thoroughly.Seasonwiththesalt.

MAKES6SERVINGS

Perserving:329calories,26gprotein,57gcarbohydrates,7gsugar,2gtotal

fat,4%caloriesfromfat,0mgcholesterol,16gfiber,457mgsodium

Black-EyedPeaswithSweetPotatoesandGreens

A wonderful combination of flavors! Serve with brown rice or fat-free

cornbread,withhotsauceontheside.

1package(10ounces)frozenkale,chard,orcollardgreens

4cupslow-sodiumvegetarianbroth

2packages(10ounceseach)frozenblack-eyedpeas,thawedanddrained

2clovesgarlic,minced

1can(18ounces)vacuum-packedunsweetenedsweetpotatoes,drained,

rinsed,andchopped,or2cupscooked

Afewdashesofliquidsmoke

Thawthegreensinthemicrowaveorabowlofboilingwateranddrain.Chop

andcombinewiththebroth,black-eyedpeas,garlic,sweetpotatoes,andliquid

smokeina large saucepan.Bringtoa boil,stirring often,thenreducethe heat

andsimmerfor20to30minutes.

MAKES4SERVINGS

Perserving:412calories,32gprotein,74gcarbohydrates,1gsugar,4gtotal

fat,8%caloriesfromfat,0mgcholesterol,22gfiber,127mgsodium

Indonesian-StyleStir-FriedPasta(Bamie)

Thisdishhasjusttherightexotictouch.

1poundsoyvermicellipasta

1mediumonion,chopped

6clovesgarlic,minced

½–1teaspooncrushedredpepper

2cupsshreddednapaorsavoycabbage

2stalkscelery,slicedthinlyonthediagonal

¼cupwater

6ounceslow-fatbeefsubstitutestrips,suchasYvesVeggieBeefTenders,

LightlifeSmartMenuSteak-StyleStrips,orMorningstarFarmsMeal

StartersSteakStrips

½cuplow-sodiumvegetarianbroth

¼cuplow-sodiumsoysauce

¾tablespoonmaplesyrup

¾tablespoondarkmolasses

2teaspoonscornstarch

1tablespooncoldwater

4scallions,slicedthinlyonthediagonal

Cookthepastainalargepotofboilingwateruntiltender.Draininacolander.

In a large, heavy nonstick wok or a skillet lightly coated with oil or cooking

spray,steam-frytheonion,garlic,andredpepperfor1minute,addingverysmall

amountsofwaterasneededtopreventstickingandburning.

Addthe cabbage,celery, and¼ cupwater. Coverand cookover highheat for

about3minutes.Addthebeefsubstitutestripsandstir-fryforabout1minute.

Combinethebroth,soysauce,maplesyrup,molasses,cornstarch,andcoldwater

in a small bowl. Stir into the pan and cook, stirring, over high heat until it

thickensandboils.

Addthedrainedpastaandtosswellwiththesauce.Topwiththescallionsand

serve.

MAKES6SERVINGS

Perserving:338calories,10gprotein,74gcarbohydrates,19gsugar,1gtotal

fat,2%caloriesfromfat,0mgcholesterol,5gfiber,505mgsodium

QuickSpinachLasagna

Although it takesa little more than an hour tomake this dish, most of that is

cookingtime;preptakesjustafewminutes.

1package(10ounces)frozenspinach,thawed

1poundreduced-fatfirmtofu

1tablespoonchoppedormincedgarlic

1teaspoonsalt

1jar(26ounces)fat-freelow-sodiumtomato-basedpastasauce

1poundwholewheatlasagnanoodles

10buttonmushrooms,sliced,or1cupothervegetableofchoice

¼cupveganparmesanornutritionalyeastflakes

Preheattheovento325°F.

Combinethespinach,tofu,garlic,andsaltinamediumbowl.

Coatthebottomofa9"×13"bakingpanwithtomatosauce,thenaddalayerof

lasagnanoodles, overlappingthemslightly.Spreadhalf ofthespinachmixture

overthenoodles.Followwithanotherlayerofnoodles,thentomatosauce,anda

layerofmushroomsorotherveggies.Repeatuntilthelayersreachthetopofthe

pan.Thefinallayershouldbesaucetoppedwithveganparmesanoryeastflakes.

Covertightlywithfoilandbakefor1hour.Stickaknifethroughthecenterof

the lasagna to be sure the noodles are completely cooked. Let stand for 15

minutes,uncovered,beforeserving.

MAKES8SERVINGS

Perserving:332calories,18gprotein,5gcarbohydrates,7gsugar,5gtotal

fat,9%caloriesfromfat,0mgcholesterol,9gfiber,284mgsodium

RecipebyJenniferReilly,RD

EggplantParmesan

Thisinterpretationofanoldfavoriteappealstomoderntastes,with“béchamel”

sauceandveganParmesanprovidingacreamycontrast.

CreamyBéchamelSauce

½mediumonion,cutintochunks

1cupwater

¾cupcookedorcannedwhitebeans,rinsedanddrained

6ouncesreduced-fatfirmsilkentofu

1tablespoonnutritionalyeastflakes

1teaspoonsalt

¼teaspoondriedgarlicgranules

Eggplant

3poundseggplant,cutinto¼"-thickslices

¾cupfinedrybreadcrumbs

3cupsfat-freetomato-basedpastasauce

2cupsCreamyBéchamelSauce

½cupveganparmesan

For the sauce: Simmer the onion with 1 cup water in a medium saucepan,

covered, for about 10 minutes. Place in a blender or food processor with the

remainingingredientsandblenduntilverysmooth.Thesaucecanberefrigerated

inacoveredcontainerforupto1week.

For the eggplant: Arrange the eggplant slices in a single layer on a nonstick

bakingsheet.Broil3"to4"fromtheheatonbothsidesuntillightlybrownedand

softinside(orgrillonanonstickindoorgrill).

Preheattheovento325°F.Layhalfoftheeggplantinthebottomofa10"round

nonstickbakingpan(orabakingpanlinedwithparchment)andtopwithhalfof

the bread crumbs. Spread with half of the pasta sauce, béchamel sauce, and

veganParmesan.Repeatwiththeremainingingredients.Bakefor20minutes,or

untilbubblyandbrownedontop.

MAKES6SERVINGS

Perserving:262calories,11gprotein,34gcarbohydrates,7gsugar,1gtotal

fat,6%caloriesfromfat,0mgcholesterol,10gfiber,697mgsodium

EasyVeggieFajitas

Thisrestaurantfavoriteiseasytomakeathome.

1mediumonion,cutintostrips

¼cuplow-sodiumvegetarianbrothorwater

1teaspoongroundcumin

3red,yellow,green,ormixedbellpeppers,cored,seeded,andcutintostrips

2cans(15ounceseach)blackbeans,drainedandrinsed

6wholewheattortillas(8"to10")

1cupno-sugar-addedtomatosalsa

Steam-fry the onion in a large, heavy nonstick skillet until soft, adding very

smallamountsofbrothorwaterasneededtopreventstickingandburning.Add

the cumin and bell peppers and cook over medium heat until the peppers are

tender.Heatthebeansonhighinthemicrowavefor1minute.

Placeatortillainalarge,heavyskilletovermedium-lowheat.Add½cupofthe

beansand ½cupof theonionmixture. Foldthetortilla inhalfover thefilling

andcookfor3minutes.Repeatwiththeremainingtortillasandfilling.Topwith

salsaandserve.

MAKES6SERVINGS

Perserving:257calories,13gprotein,50gcarbohydrates,8gsugar,2gtotal

fat,7%caloriesfromfat,0mgcholesterol,11gfiber,408mgsodium

RecipebyJenniferReilly,RD

Sides

OrangeCouscousPilaf

Couscouslookslikeagrainbutisactuallyatypeofsemolinapastathatcooks

quicklyandmakesadelicioussidedish.

2cupslow-sodiumvegetarianbroth

1cupcouscous

1cupgratedcarrots

2largeoranges,peeledandcutintosmallchunks

4teaspoonsgratedorangepeel

2tablespoonsraisins

¼teaspoonsalt

¼teaspoongroundcinnamon

Bringthebrothandcouscoustoaboilinalargesaucepanoverhighheat.Add

thecarrots, oranges, orangepeel, raisins,salt, andcinnamon. Returntoa boil,

then turnoffthe heat,cover, andlet stand for10 minutes oruntil allliquid is

absorbed.Fluffwithafork.

MAKES4SERVINGS

Perserving:238calories,7gprotein,52gcarbohydrates,4gsugar,1gtotal

fat,2%caloriesfromfat,0mgcholesterol,7gfiber,143mgsodium

BrusselsSproutswithLemonandVegetarianBacon

This is a delicious and quick brussels sprout dish. You can partially cook the

sproutsaheadof time,stopthecooking withicewater,and thenassembleand

stir-frythedishinminutesjustbeforeserving.

3poundsbrusselssprouts,trimmedandhalvedvertically

1cupchoppedvegetarianbacon(about8slices),suchasYvesVeggie

CanadianBaconorLightlifeFakin’Bacon

4scallions,chopped

¼cuplow-sodiumvegetarianbrothsalttotaste

Freshlygroundblackpeppertotaste

2tablespoonslemonjuice

Addthebrusselssproutstoasaucepanofboilingwaterandcookfor3minutes.

Drainimmediatelyandplungeintoice-coldwaterto stopthe cookingprocess.

Whentheyarecold,drainwell.

Heatalargenonstickskillet,wok,orstir-frypanoverhighheat.Addthebacon

and scallions and steam-fry until the scallions are soft, adding very small

amountsofwaterasneededtopreventstickingandburning.Addthesproutsand

broth and stir-fry for about 3 minutes. Season with the salt and pepper and

drizzlewiththelemonjuice.Tossandserveimmediately.

MAKES8SERVINGS

Perserving:71calories,12gprotein,5gcarbohydrates,1gsugar,0.5gtotal

fat,6%caloriesfromfat,0mgcholesterol,2gfiber,331mgsodium

BulgurWheatandQuinoaPilaf

Thisisatastysidedishforanymeal.

1cupbulgurwheat

1cupquinoa

1largeonion,chopped

1cupchoppedcelery

4cupslow-sodiumvegetarianbroth

¼cupmincedfreshparsley

1teaspooncrusheddriedrosemaryordriedthymeororegano

Salttotaste

Place the bulgur and quinoa in a dry heavy skillet (such as cast-iron), stir-fry

pan,orwokoverhighheatandcook,stirringconstantly,untilthegrainsmells

toasty.Removefromtheheatimmediatelyandsetaside.

Steam-frytheonionandceleryinalargenonsticksaucepanwithatightliduntil

theonionbeginstosoften.Addthebroth,bulgur,quinoa,parsley,androsemary,

thyme,ororegano. Bringto aboiloverhigh heat,thenreducetheheat tolow

andcook,covered,for20minutes.Letstandfor5minutes.Fluffwithaforkand

seasonwiththesalt.

MAKES8SERVINGS

Perserving:174calories,6gprotein,36gcarbohydrates,1gsugar,2gtotal

fat,7%caloriesfromfat,0mgcholesterol,6gfiber,46mgsodium

BroccoliStir-FryinBlackBeanSauce

Thisisacolorful,quick,andfiber-richaccompanimenttoanyAsian-stylemeal.

1teaspoonmincedorgratedfreshginger

2teaspoonscrushedgarlic

2tablespoonsChineseblackbeansauce

1bunchbroccoli

1largeonion,cutinto6wedgesandlayersseparated

2tablespoonswater

3tablespoonsdrysherryornonalcoholicsweetwine,suchasRiesling

1½teaspoonscornstarchdissolvedin½cupcoldwater

Mashthegingerandgarlictogetherinasmallbowl.Addtheblackbeansauce

andmixwell.

Dividethebroccolifloretsintobite-sizepieces.Peelandchopthestemsinto½"

piecesandstir-frywiththefloretsandonioninamediumskilletoverhighheat.

Add 2 tablespoons water, cover, and cook for 4 to 5 minutes or just until the

broccoliiscrisp-tender(addalittlemorewaterifnecessary).

Addthegingermixture,sherryorwine,andcornstarchmixtureandstiruntilthe

sauceisthickened.Serveimmediately.

MAKES4SERVINGS

Perserving:85calories,6gprotein,15gcarbohydrates,1gsugar,1gtotalfat,

4%caloriesfromfat,0mgcholesterol,0.5gfiber,416mgsodium

RoastedSweetPotatoeswithMoroccanSpices

These sweetpotatoes are easy to prepare,but your guests don’t haveto know

that.Theseedsaddcrunchaswellasspice.

1½poundsorange-fleshedsweetpotatoes,peeled,halvedlengthwise,andcut

crosswiseinto½"slices

¼cupfat-freeItaliandressing

1tablespoonmaplesyrup

1½teaspoonsgratedlemonpeel

1½teaspoonscorianderseeds

1½teaspoonscuminseeds

1½teaspoonsmustardseeds

Salttotaste

Freshlygroundblackpeppertotaste

Positionarackinthebottomthirdoftheovenandpreheattheovento375°F.

Toss the sweet potatoes, dressing, maple syrup, lemon peel, and coriander,

cumin,andmustardseedstogetherinaheavynonstickrimmedbakingsheetor

shallowbakingpan,thenspreadevenlyinashallowlayer.Sprinklewithsaltand

pepper.Roastuntiltenderandgoldenbrown,stirringoccasionally,for30to45

minutes.Servehot.

MAKES5SERVINGS

Perserving:145calories,3gprotein,33gcarbohydrates,9gsugar,1gtotal

fat,3%caloriesfromfat,0mgcholesterol,5gfiber,233mgsodium

RoastedGreenBeans,Fennel,RedPepper,andCauliflowerwith

Dill

Thisisadelicious,easy,andcolorfulvegetablepresentation.

2mediumfennelbulbs,topscutoff,halved,trimmed,andsliced

1mediumcauliflower,trimmed,brokenintoflorets,andsliced

2largeredbellpeppers,cored,seeded,andthicklysliced

6cupsfreshgreenbeans,trimmed,orfrozenwholeyounggreenbeans

½cupfat-freeItaliandressing

2tablespoonslemonjuice

2teaspoonsdrieddillweedor2tablespoonschoppedfreshdill

1teaspoondriedgarlicgranules

¼cupchoppedfennelleaves

Salttotaste

Freshlygroundblackpeppertotaste

Preheattheovento350°F.Combinethefennelbulbs,cauliflower,bellpeppers,

beans,dressing,lemonjuice,dill,garlicgranules,fennelleaves,salt,andblack

pepperinasinglelayerinalarge,shallownonstickbakingpan(usetwopansif

necessarytokeepthevegetablesin1shallowlayer).

Place the pan or pans on the bottom oven rack. Bake for about 40 minutes,

stirringoccasionallywithaspatula,untilthevegetablesaretenderandbeginning

tobrownslightly.Servehot.

MAKES8SERVINGS

Perserving:85calories,4gprotein,19gcarbohydrates,6gsugar,0.5gtotal

fat,3%caloriesfromfat,0mgcholesterol,7gfiber,254mgsodium

Desserts

Chocolate-DippedStrawberries

This treat gives you the taste of rich chocolate with the healthful goodness of

fresh fruit. Wax Orchards fat-free, fruit-sweetened organic fudge toppings are

availableinmosthealthfoodstores.Theycomeinsixvarieties.

¼cupWaxOrchardsfudgetopping

12largefreshwholestrawberries,cleaned,withstems

Heatthetopping inasmallsaucepan justuntilsoftened.Divide equallyinto2

small bowls. Hold the strawberries by the stem ends, dip in the topping, and

enjoy!

MAKES2SERVINGS

Perserving:125calories,1gprotein,29gcarbohydrates,23gsugar,1gtotal

fat,5%caloriesfromfat,0mgcholesterol,4gfiber,41mgsodium

Cranberry–Orange–PearGranolaCrisp

Cranberries, oranges, and pears are made for each other. Serve this crisp with

LemonCrème.

4largefirmripepears,peeled,cored,andthinlysliced

2½cupscranberries,thawediffrozen

Juiceandfinelygratedpeelof1mediumorange

¼teaspoonsalt

¼teaspoonfreshlygratednutmeg

¼teaspoongroundginger

¾cup(6ounces)thawedfrozenpearorapplejuiceconcentrateormixedpear,

apple,andpeachjuiceconcentrate

2tablespoonscornstarch

2cupsreduced-fatgranola(nomorethan4percentcaloriesfromfat),suchas

HealthValley

Preheattheovento400°F.Combinethepears,cranberries,orangejuice,orange

peel, salt, nutmeg, and ginger in a large bowl. Stir the juice concentrate and

cornstarchtogetherinasmallbowl.Immediatelypourintothefruitmixtureand

blendwell.Pourintoa2-quartnonstickbakingdish(orabakingdishlinedwith

parchment).Bakefor20minutes.Removefromtheovenandreducetheheatto

350°F.Stirthefruitmixturethoroughlyandsprinklethegranolaevenlyontop.

Bakefor20to30minutesoruntilthefruitissoft.Servewarm.

MAKES8SERVINGS

Perserving:201calories,3gprotein,51gcarbohydrates,27gsugar,1gtotal

fat,2%caloriesfromfat,0mgcholesterol,7gfiber,101mgsodium

LemonCrème

Thissimplydeliciouscrèmecanbeusedasapuddingoratoppingforfruitor

cake.Allyouneedarethreeingredients(youusethelemonpeelandthejuice)

andyourblender.

1package(12.3ounces)reduced-fatextra-firmsilkentofu,crumbled

⅓cupGradeA(light)maplesyruporagavenectar

3tablespoonsfreshlemonjuice

1tablespoongratedlemonpeel

Blendthetofu,maplesyruporagavenectar,lemonjuice,andlemonpeeluntil

verysmoothinablenderorfoodprocessor(orplaceinabowlanduseahand-

heldblender).Refrigerateinacoveredcontaineruntilchilled.

MAKES1¾CUPS(4SERVINGS)

Perserving:106calories,6gprotein,20gcarbohydrates,17gsugar,1gtotal

fat,5%caloriesfromfat,0mgcholesterol,0.5gfiber,88mgsodium

Variation

Lemon-GingerCrème:Foldin¼cupfinelymincedcrystallizedginger.

PineappleSherbetPops

Youcanmakethisvariationonafavoritesummertreatwithablenderandjust

sixingredients.

1package(12.3ounces)reduced-fatfirmorextra-firmsilkentofu

3tablespoonsagavenectaror⅓cupsugar

4teaspoonslemonjuice

¾teaspoonvanillaextract

1can(19ounces)juice-packedunsweetenedcrushedpineapple

¼teaspooncoconutextract

Placethetofu,agavenectarorsugar,lemonjuice,vanilla,pineapple(withjuice),

andcoconutextractinablenderandprocessuntilsmooth.Pourinto18smallice

popmolds,insertsticks,andfreezeuntilsolid.Toserve,dipthebottomsofthe

moldsinhotwaterforafewsecondssothepopsslideouteasily.

MAKES18SERVINGS

Perpopsicle:30calories,2gprotein,6gcarbohydrates,6gsugar,0.5gtotal

fat,4%caloriesfromfat,0mgcholesterol,0.5gfiber,19mgsodium

BerryMousse

Thisissoeasythatit’shardlyarecipe!Yourblenderdoesmostofthework.This

canbeeatenasapuddingorusedasatoppingforfruit.

1package(12.3ounces)reduced-fatextra-firmsilkentofu,crumbled

2¾cupsthawedfrozenunsweetenedberriesofchoice

3tablespoonssugaror2tablespoonsagavenectar

1tablespoonberryliqueur(optional)

Blendthetofu,berries,sugaroragavenectar,andliqueur,ifdesired,inablender

orfoodprocessoruntilsmooth.Spooninto4puddingdishesandrefrigerateuntil

chilled.

MAKES4SERVINGS

Perserving:123calories,7gprotein,24gcarbohydrates,17gsugar,1gtotal

fat,5%caloriesfromfat,0mgcholesterol,3gfiber,89mgsodium

Orange-ApplesauceDateCake

Thiseasylunchboxcakeis moistand delicious—andevenbetter thenextday.

Theapplesaucereplacesbotheggsandfat.

1cupunsweetenedsmoothapplesauce

1tablespoonlemonjuice

2tablespoonswater

1tablespoongratedorangepeel

1cupwholewheatpastryflour(notregularwholewheatflour)

½cupbrownsugar

¼cupoatflour(oatmealgroundinadryblenderorelectriccoffeemill)or

barleyflour

½teaspoongroundcinnamon

¼teaspoonsalt

⅛teaspoongroundnutmeg

⅛teaspoongroundallspice

1teaspoonbakingsoda

1cupchoppedpitteddates

Preheattheovento350°F.Placetheapplesauce,lemonjuice,and2tablespoons

waterinasmallsaucepanovermediumheatandwarmslowly.Addtheorange

peel.

Mixthepastry flour, brownsugar, oatorbarley flour,cinnamon, salt,nutmeg,

andallspiceinamediumbowl.

Stir the baking soda into the applesauce mixture (it will foam up). Pour

immediatelyintotheflourmixtureandstirbrieflybutthoroughly.

Addthedatesandmixbriefly.Scoopthebatterintoanonstick9"×9"cakepan,

smooththetop,andbakefor10minutes.Reducetheheatto325°Fandbakefor

25to30minutesoruntilittestsdonewithacaketester.Transfertoarackand

cool completely. Make 2 evenly spaced cuts through the cake vertically, then

horizontally,tomake9squares.

MAKES9SERVINGS

Per serving: 169 calories, 3 g protein, 41 g carbohydrates, 24 g sugar, 0.5 g

totalfat,2%caloriesfromfat,0mgcholesterol,4gfiber,199mgsodium

NOTES
INTRODUCTION
1
A. S. Nicholson et al., “Toward Improved Management of NIDDM: A
Randomized, Controlled, Pilot Intervention Using a Low-Fat, Vegetarian
Diet,”PreventiveMedicine29(1999):87–91.
2
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
CHAPTER1
1
M. Knip et al., “Environmental Triggers and Determinants of Type 1
Diabetes,”Diabetes54,suppl2(December2005):S125–36.
CHAPTER2
1
T. Kuzuya, “Prevalence of Diabetes Mellitus in Japan Compiled from
Literature,”DiabetesResearchandClinicalPractice24,suppl(1994):S15–
21.
2
H. P. Himsworth, “The Dietetic Factor Determining the Glucose Tolerance
andSensitivitytoInsulinofHealthyMen,”ClinicalScience2(1935):67–94.
3
D.B.StoneandW.E.Connor,“TheProlongedEffectsofaLow-Cholesterol,
High-Carbohydrate Diet upon the Serum Lipids in Diabetic Patients,”
Diabetes12(1963):127–32.
4
J. W. Anderson and K. Ward, “High-Carbohydrate, High-Fiber Diets for
Insulin-Treated Men with Diabetes Mellitus,” American Journal of Clinical
Nutrition32(1979):2312–21.
5
R.J.Barnard,T.Jung,andS.B.Inkeles,“DietandExerciseintheTreatment
ofNIDDM:TheNeedforEarlyEmphasis,”DiabetesCare17(1994):1469–
72.
6
A. S. Nicholson et al., “Toward Improved Management of NIDDM: A
Randomized, Controlled, Pilot Intervention Using a Low-Fat, Vegetarian
Diet,”PreventiveMedicine29(1999):87–91.
7
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.

8
A.E.Bunner,C.L.Wells,J.Gonzales,U.Agarwal,E.Bayat,N.D.Barnard.
A dietary intervention for chronic diabetic neuropathy pain: a randomized
controlled pilot study. Nutrition & Diabetes 2015 May 26;5:e158. doi:
10.1038/nutd.2015.8.
9
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
10
I.M.Stratton,A.L.Adler,andH.A.Neil,“AssociationofGlycaemiawith
Macrovascular and Microvascular Complications of Type 2 Diabetes
(UKPDS35):ProspectiveObservationalStudy,”BritishMedicalJournal321
(2000):405–12.
11
UKProspectiveDiabetesStudy(UKPDS)Group,“EffectofIntensiveBlood-
Glucose Control with Metformin on Complications in Overweight Patients
withType2Diabetes(UKPDS34),”Lancet352(1998):854–65.
12
D.Ornishetal.,“CanLifestyleChangesReverseCoronaryHeartDisease?”
Lancet336(1990):129–33.
13
————, “Intensive Lifestyle Changes for Reversal of Coronary Heart
Disease,”JournaloftheAmericanMedicalAssociation280(1998):2001–7.
14
Y.Yokoyama,K.Nishimura,N.D.Barnard,etal.Vegetariandietsandblood
pressure:ameta-analysis.JAMAInternationalMedicine2014;174(4):577–87.
15
K. F. Petersen et al., “Impaired Mitochondrial Activity in the Insulin-
ResistantOffspringofPatientswithType2Diabetes,”NewEnglandJournal
ofMedicine350(2004):664–71.
16
Ibid.
17
L. M. Sparks et al., “A High-Fat Diet Coordinately Downregulates Genes
Required forMitochondrial Oxidative Phosphorylationin Skeletal Muscle,”
Diabetes54(2005):1926–33.
18
A. V. Greco et al, “Insulin Resistance in Morbid Obesity: Reversal with
IntramyocellularFatDepletion,”Diabetes52(2002):144–51.
19
L.M.Goffetal.,“VeganismandItsRelationshipwithInsulinResistanceand
Intramyocellular Lipid,”European Journal of Clinical Nutrition 59 (2005):
291–8.
CHAPTER3
1
D. M. Nathan et al. and the Diabetes Control and Complications

Trial/Epidemiology of Diabetes Interventions and Complications
(DCCT/EDIC) Study Research Group, “Intensive Diabetes Treatment and
Cardiovascular Disease in Patients with type 1 Diabetes,” New England
JournalofMedicine353(2005):2643–53.
2
Diabetes Control and Complications Trial Research Group, “The Effect of
Intensive Treatment of Diabetes on the Development and Progression of
Long-Term Complications in Insulin-Dependent Diabetes Mellitus,” New
EnglandJournalofMedicine329(1993):977–86.
3
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
inWomenwithNormalRenalFunctionorMildRenalInsufficiency,”Annals
ofInternalMedicine138(2003):460–7.
4
J. Karjalainen et al., “A Bovine Albumin Peptide as a Possible Trigger of
Insulin-DependentDiabetesMellitus,”NewEnglandJournalofMedicine327
(1992):302–7.
5
A.C. Alting,R. G.J. M.Meijer, andE. C.H. vanBeresteijn, “Incomplete
elimination of the ABBOS Epitope of Bovine Serum Albumin under
SimulatedGastrointestinalConditionsofInfants,”DiabetesCare20(1997):
875–80.
6
D. Hammond-McKibben and H. M. Dosch, “Cow’s Milk, Bovine Serum
Albumin,and IDDM: CanWeSettle theControversies?” DiabetesCare 20
(1997):897–901.
7
Ibid.
8
American Academy of Pediatrics Work Group on Cow’s Milk Protein and
DiabetesMellitus,“InfantFeedingPracticesandTheirPossibleRelationship
totheEtiologyofDiabetesMellitus,”Pediatrics94(1994):752–4.
9
H.K.Akerblometal.,“DietaryManipulationofBetaCellAutoimmunityin
InfantsatIncreasedRiskofType1Diabetes:APilotStudy,”Diabetologia48
(2005):829–37.
10
P. S. Clyne and A. Kulczycki Jr. Human breast milk contains bovine IgG:
relationshiptoinfantcolic?”Pediatrics87(1991):439–44.
11
K. Sadeharju et al., “Enterovirus Infections as a Risk Factor for Type 1
Diabetes: Virus Analyses in a Dietary Intervention Trial,” Clinical and
ExperimentalImmunology132(2003):271–7.
CHAPTER4

1
L.M.Goffetal.,“VeganismandItsRelationshipwithInsulinResistanceand
Intramyocellular Lipid,”European Journal of Clinical Nutrition 59 (2005):
291–8.
2
E.C. Rizos, E.E. Ntzani, E. Bika, et al. Association between omega-3 fatty
acidsupplementationandriskofmajorcardiovasculardiseaseevents.JAMA.
2012;308:1024-33.
3
S.M.Kwak,S.K.Myung,Y.J.Lee,H.G.Seo;KoreanMeta-analysisstudy
Group... Efficacy ofomega-3fatty acidsupplements (eicosapentaenoic acid
and docosahexaenoic acid) in the secondary prevention of cardiovascular
disease.ArchivesofInternalMedicine2012;172(9):686–94.
4
S. Tonstad, T. Butler, R. Yan, G. E. Fraser. Type of vegetarian diet, body
weight,andprevanenceoftype2diabetes.DiabetesCare.2009;32:791–96.
5
M.Kaushik,D.Mozaffarian,D.Spiegelman,etal.Long-chainomega-3fatty
acids,fishintake,andtheriskoftype2diabetesmellitus.AmericanJournal
ofClinicalNutrition2009;90:613–20;N.D.Barnard,J.Cohen,D.J.Jenkins,
etal.Alow-fat,vegandietimprovesglycemiccontrolandcardiovascularrisk
factors in a randomized clinical trial in individuals with type 2 diabetes.
DiabetesCare2006;29:1777–83.
6
N.D.Barnard,J.Cohen,D.J. Jenkins,G.Turner-McGrievy, L.Gloede, B.
Jaster, K. Seidl, A. A. Green, S. Talpers. A low-fat, vegan diet improves
glycemiccontrolandcardiovascularriskfactorsinarandomizedclinicaltrial
inindividualswithtype2diabetes.DiabetesCare2006;29:1777–83.
7
Y. Papanikolaou et al.,“Bean Consumption by AdultsIs Associated with a
MoreNutrientDenseDietandaReducedRiskofObesity,”presentedatthe
ExperimentalBiologyConference,April1–5,2006,SanFrancisco,CA.
8
V. L. Fulgoni et al., “Bean Consumption by Children Is Associated with
BetterNutrientIntakeandLowerBodyWeightsandWaistCircumferences,”
presented at the Experimental Biology Conference, April 1–5, 2006, San
Francisco,CA.
9
S. J. Kim, R. J. de Souza, V. L. Choo, et al. Effect of dietary pulse
consumption on body weight : a systematic review and meta-analysis of
randomizedcontrolledtrials.AmJClinNutr;2016:103:1213-23.
10
V.Ha,J.L.Sievenpiper,R.J.deSouza,etal.Effectofdietarypulseintake
on established lipid targets for cardiovascular risk reduction: a systematic
reviewandmeta-analysisofrandomizedcontrolledtrials.CanadMedAssoJ.
2014;186:e252-62.

11
D.G.Bailey,G.Dresser,M.O.Arnold.Grapefruit-medicaitonninteractions:
forbiddenfruitoravoidableconsequences?CMAJ.2013;185:309-16.
12
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
inWomenwithNormalRenalFunctionorMildRenalInsufficiency,”Annals
ofInternalMedicine138(2003):460–7.
13
E. Giovannucciet al., “Calciumand Fructose Intakein Relation to Riskof
ProstateCancer,”CancerResearch58(1998):442–7.
14
J.M.Chanetal.,“DairyProducts,Calcium,andProstateCancerRiskinthe
Physicians’HealthStudy,”AmericanJournalofClinicalNutrition74(2001):
549–54.
15
X. Gao,M. P. LaValley, K. L.Tucker. Prospective studiesof dairy product
andcalciumintakesandprostatecancerrisk:ameta-analysis.Journalofthe
NationalCancerInstitute2005dec7;97(23):1768–77.
16
K.M.Wilson,e.L.Giovannucci,L.A.Mucci.Lifestyleanddietaryfactors
in the prevention of lethal prostate cancer. Asian Journal of Andrology.
2012;14:265–74.
17
H. L. Newmark, r. P. Heaney. Dairy products and prostate cancer risk.
NutritionandCancer2010;62(3):297–99.
18
S. C. Larsson, N. Orsini, and A. Wolk, “Milk, Milk Products and Lactose
Intake and Ovarian Cancer Risk: A Meta-Analysis of Epidemiological
Studies,”InternationalJournalofCancer118(2006):431–41.
19
J. M. Genkinger et al., “Dairy Products and Ovarian Cancer: A Pooled
Analysis of 12 Cohort studies,” Cancer Epidemiology Biomarkers &
Prevention15(2006):364–72.
20
B. Qin, P. G. Moorman, A.J. Alberg, etal. Dairy, calcium, vitaminD and
ovariancancer risk inAfrican-American women.British Journalof Cancer
2016;2016;115(9):1122–30.
21
D. J. Jenkins et al., “Glycemic Index of Foods: A Physiological Basis for
CarbohydrateExchange,”AmericanJournalofClinicalNutrition34(1981):
362–6.
22
Ibid.
23
J. Brand-Miller et al., “Low-Glycemic Index Diets in the Management of
Diabetes,”DiabetesCare26(2003):2261–7.
24
N. C. Howarth, e. Saltzman, and s. B. Roberts, “Dietary Fiber and Weight
regulation,”NutritionReviews59(2001):129–39.

25
N. D. Barnard et al., “the Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
26
M.G.Craneandc.Sample,”“RegressionofDiabeticNeuropathywithTotal
Vegetarian(Vegan)Diet,”JournalofNutritionalMedicine4(1994):431–9.
27
A.E.Bunner,c.L.Wells,J.Gonzales,u.Agarwal,E.Bayat,N.D.Barnard.
A dietary intervention for chronic diabetic neuropathy pain: a randomized
controlled pilot study. Nutrition & Diabetes 2015 May 26;5:e158. doi:
10.1038/nutd.2015.8.
28
G.M.Turner-McGrievy,etal.Effectsofalow-fat,vegandietandastepII
diet on macro- and micronutrient intakes in overweight, postmenopausal
women,Nutrition20(2004):738–46.
29
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
inWomenwithNormalRenalFunctionorMildRenalInsufficiency,”Annals
ofInternalMedicine138(2003):460–7.
30
V. Melina, W. Craig, s. Levin. Position of the Academy of Nutrition and
Dietetics:vegetariandiets.JournaloftheAcademyofNutritionandDietetics
2016;116:1970–80.
31
E. C. Westman et al. Effect of a 6-month adherence to a very low
carbohydratedietprogram.AmericanJournalofMedicine113(2002):30–36.
CHAPTER6
1
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
2
N. C. Howarth, e. Saltzman, and s. B. Roberts, “Dietary Fiber and Weight
Regulation,”NutritionReviews59(2001):129–39.
3
Barnardetal.,“TheEffectsofaLow-Fat,Plant-BasedDietaryIntervention.”
4
J. A. Vernarelli, d. C. Mitchell, B. J. Rolls, t. J. Hartman. Dietary energy
densityisassociatedwithobesityandotherbiomarkersofchronicdiseasein
usadults.EuropeanJournalNutrition2015;54:59–65.
5
A. M. Dattilo and P. M. Kris-Etherton, “Effects of Weight Reduction on
Blood Lipids and Lipoproteins: A Meta-Analysis,” American Journal of
ClinicalNutrition56(1992):320–8.
6
E. C. Westman et al., “Effect of a 6-Month Adherence to a Very Low

CarbohydrateDietProgram,”AmericanJournalofMedicine113(2002):30–
6.
7
W.S.Yancyetal.,“ALow-Carbohydrate,KetogenicDietversusaLow-Fat
DiettoTreatObesityandHyperlipidemia,”AnnalsofInternalMedicine130
(2004):769–77.
8
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
in Women with Normal Renal Function or Mild Renal Insufficiency,”
AmericanJournalofMedicine118(2005):460–7.
9
J. Coresh et al., “Prevalence of chronic Kidney Disease and Decreased
Kidney Function in the Adult us Population: Third National Health and
Nutrition Examination Survey,” American Journal of Kidney Diseases 41
(2003):1–12.
10
K. D. Hall, t. Bemis, r. Brychta, et al. Calorie for calorie, dietary fat
restrictionresultsinmorebodyfatlossthancarbohydraterestrictioninpeople
withobesity.CellMetabolism.2015;22:427–36.
CHAPTER7
1
G. B. Bolli and J. E. Gerich, “The ‘Dawn Phenomenon’—A Common
OccurrenceinBothNon-Insulin-DependentandInsulin-DependentDiabetes
Mellitus,”NewEnglandJournalofMedicine310(1984):746–50.
2
E.Selvinetal.,“Meta-analysis:A1CandCardiovascularDiseaseinDiabetes
Mellitus,”AnnalsofInternalMedicine141(2004):421–31.
3
National Cholesterol Education Program, “Third Report of the National
Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
TreatmentPanelIII)FinalReport,”Circulation106(2002):3143–421.
4
S.M.Grundy,etal.“ImplicationsofRecentClinicalTrialsfortheNational
Cholesterol Education Program Adult Treatment Panel III Guidelines,”
Circulation110(2004):227–39.
5
AmericanDiabetesAssociation,2017
CHAPTER9
1
M. R. Yeomans et al., “Effects of Nalmefene on Feeding in Humans,”
Psychopharmacology100(1990):426–32.
2
D. J. Jenkins et al., “Low-Glycemic Index Diet in Hyperlipidemia: Use of
Traditional Starchy Foods,” American Journal of Clinical Nutrition 46

(1987):66–71.
CHAPTER10
1
J.Hlebowicz,A.Hlebowicz,s.Lindstedt,etal.Effectsof1and3gcinnamon
ongastricemptying,satiety,andpostprandialbloodglucose,insulin,glucose-
dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin
concentrations in healthy subjects. American Journal of Clinical Nutrition
2009;89:815–21.
2
R.M. vandam, F.B. Hu,L.Rosenberg,s.Krishnan, J.R. Palmer.Dietary
calciumand magnesium,majorfood sources,and riskof type2 diabetesin
U.S.blackwomen.DiabetesCare2006Oct;29(10):2238–43.
3
W. Mertz, “Chromium Occurrence and Function in Biological systems,”
PhysiologicalReviews49(1969):163–239.
4
K. N. Jeejeebhoy et al., “Chromium Deficiency, Glucose Intolerance, and
NeuropathyReversedbyChromiumSupplementationinaPatientReceiving
Long-term Total Parenteral Nutrition,” American Journal of Clinical
Nutrition30(1977):531–8.
5
G.W.Landman,h.J.Bilo,s.t.Houweling,N.Kleefstra.Chromiumdoesnot
belong in the diabetes treatment arsenal: current evidence and future
perspectives.WorldJournalofDiabetes2014;5:160–64.
6
S.Jacobetal.,“OralAdministrationofRAC-Alpha-LipoicAcidModulates
Insulin Sensitivity in Patients with Type-2 Diabetes Mellitus: A Placebo-
ControlledPilotTrial,”FreeRadicalBiology&Medicine27(1999):309–14.
7
D.Ziegler,P.A.Low,W.J.Litchy,etal.Efficacyandsafetyofantioxidant
treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the
NATHAN1trial.DiabetesCare2011;34(9):2054–60.
CHAPTER11
1
W. C.Knowleret al.,“Reductionin theIncidence ofType 2Diabetes with
LifestyleInterventionorMetformin,”NewEnglandJournalofMedicine346
(2002):393–403.
2
D. E. Thomas, e. J. Elliott, G. A. Naughton. Exercise for type 2 diabetes
mellitus.CochraneDatabaseSystemReview2006Jul19;(3):cd002968.
3
N.G.Bouléetal.,“EffectsofExerciseonGlycemicControlandBodyMass
inType2DiabetesMellitus:AMeta-AnalysisofControlledClinicalTrials,”
JournaloftheAmericanMedicalAssociation286(2001):1218–27.

4
G.Huetal.,“PhysicalActivity,CardiovascularRiskFactors,andMortality
amongFinnishAdultswithDiabetes,”DiabetesCare28(2005):799–805.
5
————, “Leisure Time, Occupational, and Commuting Physical Activity
andtheRiskofStroke,”Stroke36(2005):1994–9.
6
DiabetesResearchinChildrenNetwork(DirecNet)studyGroup.Theeffects
ofaerobicexerciseonglucoseandcounterregulatoryhormoneconcentrations
inchildrenwithtype1diabetes.DiabetesCare29(2006):20–25.
CHAPTER12
1
N. D. Barnard, L. W. Scherwitz, and D. Ornish. “Adherence and
Acceptability of a Low-Fat, Vegetarian Diet among Patients with Cardiac
Disease,”JournalofCardiopulmonaryRehabilitation12(1992):423–31.
2
D.Ornishetal.,“CanLifestyleChangesReverseCoronaryHeartDisease?”
Lancet336(1990):129–33.
3
————, “Intensive Lifestyle Changes for Reversal of Coronary Heart
Disease.”
4
N. D. Barnard, A. Akhtar, and A. Nicholson, “Factors That Facilitate
Compliance to Lower Fat Intake,” Archives of Family Medicine 4 (1995):
153–8.
5
C.B.EsselstynJr.,“Updatinga12-YearExperiencewithArrestandReversal
Therapy for Coronary Heart Disease (an Overdue Requiem for Palliative
Cardiology),”AmericanJournalofCardiology84(1999):339–41.
6
D.J.Jenkins,A.Mirrahimi,K.Srichaikul,etal.Soyproteinreducesserum
cholesterolbybothintrinsic andfooddisplacementmechanisms.Journalof
Nutrition2010;140(12):2302s–2311s.
7
P. M. Kris-Etherton, F. B. Hu, E. Ros, J. Sabaté. The role of tree nuts and
peanuts in the prevention of coronary heart disease: multiple potential
mechanisms.JournalofNutrition2008Sep;138(9):1746s–1751s.
8
D.J.Jenkinsetal.,“DirectComparisonofaDietaryPortfolioofCholesterol-
Lowering Foods with a Statin in Hypercholesterolemic Participants,”
AmericanJournalofClinicalNutrition81(2005):380–7.
9
A.Poobalan,L. Aucott,W.C. Smith,A.Avenell, r. Jung,J.Broom,A.M.
Grant.Effectsofweightlossinoverweight/obeseindividualsandlong-term
lipidoutcomes—asystematicreview.ObesityReview2004;5(1):43–50.
10
S. Berkow and N. D. Barnard, “Blood Pressure Regulation and Vegetarian

Diets,”NutritionReviews63(2005):1–8.
CHAPTER13
1
M. G. Crane, “Sample c. Regression of Diabetic Neuropathy with Total
Vegetarian(Vegan)Diet,”JournalofNutritionalMedicine4(1994):431–9.
2
D.Ziegler.Efficacyandsafetyofantioxidanttreatment.
3
D.F.Horrobin,“EssentialFattyAcidsintheManagementofImpairedNerve
FunctioninDiabetes,”Diabetes46,suppl2(1997):S90–93.
4
A.A.Sima.Acetyl-L-carnitineindiabeticpolyneuropathy:experimentaland
clinicaldata.CNSDrugs2007;21suppl1:13–23;discussion45–6.
5
I. De Leeuw et al., “Long Term Magnesium Supplementation Influences
Favourably the Natural Evolution of Neuropathy in Mg-Depleted type 1
DiabeticPatients(T1dm),”MagnesiumResearch17(2004):109–14.
6
M. Lu et al., “Prospective Study of Dietary Fat and Risk of Cataract
Extraction among US Women,” American Journal of Epidemiology 161
(2005):948–59.
7
N. Karas-Kuzelicki, V. Pfeifer, J. Lukac-Bajalo. Synergistic effect of high
lactase activity genotype and galactose-1-phosphate uridyl transferase
(GALT) mutations on idiopathic presenile cataract formation. Clinical
Biochemistry2008Jul;41(10-11):869–74.
8
L.Ma,X.M.Lin.Effectsofluteinandzeaxanthinonaspectsofeyehealth.
JournaloftheScienceofFoodandAgriculture2010Jan15;90(1):2–12.doi:
10.1002/jsfa.3785.
9
R. G. Cumming, P. Mitchell, and W. Smith, “Diet and Cataract: The Blue
MountainsEyestudy,”Ophthalmology107(2000):450–6.
10
M.S.Morrisetal.,“ModerateAlcoholicBeverageIntakeandEarlyNuclear
andCorticalLensOpacities,”OphthalmicEpidemiology11(2004):53–65.
11
L. Azadbakht, s. Atabak, A. Esmaillzadeh. Soy protein intake, cardiorenal
indices, and c-reactive protein in type 2 diabetes with nephropathy: a
longitudinalrandomizedclinicaltrial.DiabetesCare2008Apr;31(4):648–54.
12
Y.Yokoyama,K.Nishimura,N.D.Barnard,etal.Vegetariandietsandblood
pressure:ameta-analysis.JAMAInternationalMedicine2014;174(4):577–87.

ABOUTTHEAUTHOR

Neal Barnard, MD, FACC, is the founder and president of the Physicians

CommitteeforResponsibleMedicine.Hehasauthoredmorethan70scientific

publications,aswellas19books,includingthebestsellersPowerFoodsforthe

Brain, 21-Day Weight Loss Kickstart, and Dr. Neal Barnard’s Program for

Reversing Diabetes, and the new Dr. Neal Barnard's Cookbook for Reversing

Diabetes.Dr.Barnardisafrequentlecturerappearingthroughouttheworldand

anadjunctprofessorofmedicineattheGeorgeWashingtonUniversitySchoolof

Medicine.HelivesinWashington,DC.

Thisbookisintendedasareferencevolumeonly,notasamedicalmanual.

Theinformationgivenhereisdesignedtohelpyoumakeinformeddecisionsaboutyourhealth.Itisnot

intendedasasubstituteforanytreatmentthatmayhavebeenprescribedbyyourdoctor.Ifyoususpectthat

youhaveamedicalproblem,weurgeyoutoseekcompetentmedicalhelp.

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